Field Triage Errors: A Cross-Sectional Study of Emergency Responders in a Virtual Reality Mass Casualty Simulation

Abstract

Objective: This study explored the prevalence and attributes of triage errors made by emergency responders during virtual reality simulations of mass casualty incidents.

Methods: The study analyzed errors made by 99 emergency responders during their triage and treatment of a mass casualty incident in virtual reality. Responders received training on the Sort, Assess, Life-saving Intervention, Treatment, Transport (SALT) protocol, then responded to a virtual bombed subway station. Responder accuracy, efficiency, and application of treatments were tracked. Error analysis was performed through the lens of human factors. Accordingly, errors were categorized by their nature: either perception, proficiency, or procedure.

Results: Responders correctly triaged 70% of virtual patients, and 78% demonstrated relative efficiency. Interaction times between responders and patients averaged 20 seconds. The time to assess and treat all patients for life-threatening bleeding injuries across the entire scene averaged six minutes. Most errors were related to proficiency (e.g., competence or experience). However, procedural errors (shortcomings of SALT) and perceptual errors (degraded sensory input from programmed environmental chaos, i.e., virtual smoke/debris and louder sound) were also observed. Most errors were related to patients with either respiratory issues or multiple injuries.

Conclusion: Virtual reality (VR) offered a controlled environment for studying errors made by emergency responders in a mass casualty incident, which will lead to improved training and protocols to better prepare them for these events.

Keywords: clinical competence; computer simulation; diagnostic; education; emergency medical services; emergency responders; emergency treatment; errors; mass casualty incidents; professional; professional competence; triage; virtual reality.