Virtual Reality Simulation for Assessment of Hemorrhage Control and SALT Triage Performance: A Comparison of Prehospital to In-Hospital Emergency Responders.
Prehospital and Disaster Medicine · 2025-08-01 · Observational study
Abstract
INTRODUCTION: Targeted identification, effective triage, and rapid hemorrhage control are essential for optimal outcomes of mass-casualty incidents (MCIs). An important aspect of Emergency Medical Service (EMS) care is field triage, but this skill is difficult to teach, assess, and research. STUDY OBJECTIVE: This study assessed triage efficacy and hemorrhage control of emergency responders from different professions who used the Sort, Assess, Life-Saving Treatment (SALT) triage algorithm in a virtual reality (VR) simulation of a terrorist subway bombing. METHODS: After a brief just-in-time training session on the SALT triage algorithm, participants applied this learning in First VResponder, a high-fidelity VR simulator (Tactical Triage Technologies, LLC; Powell, Ohio USA). Participants encountered eleven virtual patients in a virtual scene of a subway station that had experienced an explosion. Patients represented individuals with injuries of varying severity. Metrics assessed included triage accuracy and treatment efficiency, including time to control life-threatening hemorrhage. Independent Mann-Whitney analyses were used to compare two professional groups on key performance variables. RESULTS: The study assessed 282 participants from the ranks of EMS clinicians and medical trainees. Most (94%) participants correctly executed both global SALT sort commands. Participants triaged and treated the entire scene in a mean time of 7.8 decimal minutes, (95%CI, 7.6-8.1; SD = 1.9 decimal minutes) with a patient triage accuracy rate of 75.8% (95%CI, 74.0-77.6; SD = 15.0%). Approximately three-quarters (77%) of participants successfully controlled all life-threatening hemorrhage, within a mean time of 5.3 decimal minutes (95%CI, 5.1-5.5; SD = 1.7 decimal minutes). Mean time to hemorrhage control per patient was 0.349 decimal minutes (SD = 0.349 decimal minutes). Overall, EMS clinicians were more accurate with triage (P ≤ .001) and were faster at triage, total hemorrhage control (P < .01), and hemorrhage control per patient (P < .004) than medical trainees. CONCLUSIONS: Through assessments using VR simulation, it was observed that more experienced individuals from the paramedic (PM) workforce out-performed less experienced medical trainees. The study also observed that the medical trainees performed acceptably, even though their only formal training in SALT triage was a 30-minute, just-in-time lecture. Both of these findings are important for establishing evidence that VR can serve as a valid platform for assessing the complex skills of triage and treatment of an MCI, including the assessment of rapid hemorrhage control.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Terror attacks & active shooter events · Mass casualty triage · Paramedics & EMTs · Students · Time intervals · Tourniquet · Triage instruments
Related articles
- Implementation of a workshop for mass casualty incident triage training using an immersive virtual reality simulation. (AEM Educ Train, 2024)
- First Responder Accuracy Using SALT during Mass-casualty Incident Simulation. (Prehosp Disaster Med, 2016)
- Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage. (Am J Emerg Med, 2021)
- Bombings specific triage (Bost Tool) tool and its application by healthcare professionals. (World J Emerg Med, 2015)
- Intuitive versus Algorithmic Triage. (Prehosp Disaster Med, 2018)
- Does START triage work? An outcomes assessment after a disaster. (Ann Emerg Med, 2009)