Mass Casualty Incident

Exonicus partnered with US Madigan Army Medical Center to deliver a high-fidelity, virtual-reality simulation of a mass casualty event. Relying on a wealth of previous experience, Exonicus helped Madigan to engineer a controlled environment for building the resilience of combat medical personnel to stress.

Preparing military medics for forward deployments has always been a central problem. Exonicus, together with Madigan Emergency Medical Research Department, started out this project after identifying three underlying issues – the speed of medical providers acclimating to deployed environments while assuming medical provision roles, training for combat stress while managing complex trauma and the maintenance of key skills and readiness while deployment to resource limited areas.

High-fidelity medical simulation training is prohibitively expensive and requires more resources than most forward deployed locations can offer. However, by leveraging immersive virtual reality (IVR) technology, the resulting product could revolutionize the medical simulation field by driving down costs and enhancing the fidelity of the immersion with realistic rendering of the environment and injuries. Using a headset and a computer for a setup cost of less than $3000, the solution would be accessible even in offline environments.

Mass casualty events are some of the most stressful for medical professionals, and thus, they are hard to train for. Exonicus’ goal in this project was to deliver a solution that was realistic to potential deployment environments, added in combat stressors, and was easily accessible in resource-limited areas, so Madigan Army Medical Center would have an innovative new way to tackle old medical training issues.

Exonicus and Madigan’s relationship formally began in 2018 with cooperation on a previous project that prototyped the current Exonicus system. Madigan and Exonicus developed a complex medical decision trainer in standard military trauma bay. The success of the previous project set up the mass casualty development for success by creating a shared knowledge base and strong working relationships.

Exonicus also had relevant expertise from across disciplines and geographies, being comprised of medical providers, UI/UX professionals, software engineers, program managers, artists, and military personnel. Members of our team also possess business acumen and partnership opportunities that enriches the company’s creative mind.

The scenario created in the project emulates what front-line emergency medical physicians might face in terms of distractions, available tools, and patients. The Role 2 medical tent offers more tools than first responders have, but less than the theater hospital would be able to provide. Patients have a variety of traumas, emulating the conditions of terror attack victims. Burns, head traumas, limb amputations, and airway blockages are common.

The Mass Casualty Scenario is unique for how it trains and challenges practitioners to make smart decisions. The first patient who arrives is a lost cause, and no amount of attention will stabilize his condition. Young or untrained medical professionals may hyperfocus on a patient to deliver quality medical care, but a mass casualty event requires that the user split time and attention amongst multiple patients and rapidly respond to evolving patient statuses. Realistic time pressure prepares physicians for a real-life mass casualty event.

Aiding in the decision-making process is the delivery of relevant and timely information. As a user treats the patients, five Kitware Pulse engines update each patient’s anatomy to match the situation. The patient’s heart rate, breathing, level of consciousness, and other internal variables change with the treatments applied. For patient assessments that are typically tactile or physical, such as checking the pulse, small pop-ups display the pulse rate. Visual cues, such as pupil dilation or patient pain responses, are programmed into the software. This creates an immersive virtual environment where users can see the effects of their interventions in real time.

Further feedback is delivered at the end of the scenario. When the user has dispositioned each patient, the system presents a scorecard that tracks the time to identify injuries, records the critical interventions, and grades intervention decisions. Specific and targeted feedback accelerates the learning process. A teacher does not need to review a test key or write-up what the learner needs to focus on. Instead, the system instantly returns an analysis of the user’s actions for them to analyze and understand their weaknesses.

This solution is ready for today because of years of testing, research, and human trials. Over the years, Exonicus conducted numerous surveys with Vidzeme University of Applied Sciences, Digital Health Cluster Latvia, and Rīga Stradiņš University, proving the importance and viability of computer-generated simulations in medical education. Exonicus routinely tests its scenarios in deployed environments, at the 5G testbed at Ādaži Military Base, and in other testing setups. This enables adaptive feedback to drive development forward.