A Serious Game for Enhancing Rescue Reasoning Skills in Tactical Combat Casualty Care: Development and Deployment Study

Abstract

Background: Serious games (SGs) have emerged as engaging and instructional digital simulation tools that are increasingly being used for military medical training. SGs are often compared with traditional media in terms of learning outcomes, but it remains unclear which of the 2 options is more efficient and better accepted in the process of knowledge acquisition.

Objective: This study aimed to create and test a scenario-based system suitable for enhancing rescue reasoning skills in tactical combat casualty care.

Methods: To evaluate the effectiveness of the SGs, a randomized, observational, comparative trial was conducted. A total of 148 members from mobile medical logistics teams were recruited for training. Pre- and posttraining assessments were conducted using 2 different formats: a video-based online course (n=78) and a game simulation (n=70). We designed 3 evaluation instruments based on the first 2 levels of the Kirkpatrick model (reaction and learning) to measure trainees' satisfaction, knowledge proficiency, and self-confidence.

Results: There were 4 elements that made up the learning path for the SGs: microcourses (video-based online courses), self-test, game simulation, and record query. The knowledge test scores in both groups were significantly higher after the intervention (t₁₅₄=-6.010 and t₁₃₈=-7.867, respectively; P<.001). For 5 simulation cases, the average operation time was 13.6 (SD 3.3) minutes, and the average case score was 279.0 (SD 57.6) points (from a possible total of 500 points), with a score rate of only 44% (222/500 points) to 67% (336/500 points). The results indicated no significant difference in trainees' satisfaction between the 2 training methods (P=.04). However, the game simulation method outperformed the video-based online course in terms of learning proficiency (t₁₄₆=-2.324, P=.02) and self-perception (t₁₄₆=-5.492, P<.001).

Conclusions: Despite the high satisfaction reported by trainees for both training methods, the game simulation approach demonstrated superior efficiency and acceptance in terms of knowledge acquisition, self-perception, and overall performance. The developed SG holds significant potential as an essential assessment tool for evaluating frontline rescue skills and rescue reasoning in mobile medical logistics teams.

Keywords: combat casualty care; medical education; medical service support; military exercise; simulation training; virtual reality.

Figure 1

The serious game operation process.

Figure 2

Simulation intervention.

Figure 3

Software interface of the simulation training system for tactical combat casualty care (TCCC) skills, including the (A) home page; (B) microcourses: TCCC summary, hemostasis, airway management and tension pneumothorax, fracture fixation, burn treatment, cycle management, eye trauma and craniocerebral trauma, painkillers and antibiotics; (C) self-assessment; (D) game simulation including 5 cases; (E) case background; (F) distant view of the casualty, the total score, the action to take, and score associated with that action; (G) close shot of the wound, with a task to choose the pain medication and the result of the choice; (H) standard rescue flow chart using patient 3 as the example; (I) record query including the evaluation records and case records.

Figure 4

Knowledge test scores: (A) box plots, (B) frequency histogram.

Figure 5

Boxplots of the (A) operating times for the 5 cases and (B) scores of the 5 cases.