Using virtual reality to take training to the next level

Mark Hodkinson, Consultant Paramedic at Thames Valley Air Ambulance

When you think about virtual reality headsets, surgical training probably isn’t the first image that comes to mind. Virtual reality may be more commonly connected to the world of gaming, but for pre-hospital emergency medicine, the technology could be game-changing.

Back in 2022, Thames Valley Air Ambulance brought our aviation operations in-house. At that time, we worked with MAXRES to produce virtual reality training for our new helicopter, G-TVLY. The courses, filmed using a 360-degree camera, focused on emergency strategies such as how to escape the cockpit and how to deploy fire extinguishers. It was the first time we’d used virtual reality to allow our crews to experience life-like situations during training.

These courses, which have been in use ever since, got us thinking. Immersing our crews in an aviation situation was so effective, we wondered if the same could be achieved for surgical procedures. Thanks to generous funding from the Peter Sowerby Foundation, this idea has now been turned into (virtual) reality.

What does the training cover?

Our latest virtual reality lessons replicate three procedures we describe as high acuity, low occurrence – or HALO. Firstly intubation, when a tube is placed into the trachea to maintain an open airway, as well as thoracostomy, a surgical hole in the chest wall that allows air or blood to drain, and thoracotomy. Thoracotomies are one of the most major surgical interventions our crews carry out, as they involve making an incision in the chest wall to gain access to the lungs and heart.

For me, personally, I’ve performed just three thoracotomies in 13 years. Though intubations are more common, with our crews carrying out 541 last year, there could not be higher stakes when it comes to delivering this level of care. These three procedures are all interventions that need to be executed correctly on the first attempt, under pressure.

Other ways of practicing surgeries, using realistic manikins or ‘medical meat’ for example, are great for more basic competencies. But more complex skills are harder to replicate, as nothing is going to react the same way as a human body would or be 100 per cent anatomically correct.

For that reason, our clinical educators performed these three procedures on a cadaver, which was donated to medical research. We didn’t take this lightly. What an incredible legacy to leave behind, helping to train critical care paramedics and doctors in procedures which could save a life.

Now complete, these new virtual reality lessons will form part of our training toolkit, alongside other scenario-based learning involving manikins, bystanders, and real world-style distractions and complications. They’ll form part of a blended approach to learning. With virtual reality, plus theory, alongside practice, we’ll be offering our critical care paramedics and doctors the full suite of training.

Who will benefit?

As far as we know, Thames Valley Air Ambulance is among the first Helicopter Emergency Medical Service to use virtual reality in this way and we’re working on ways we can share this training within the sector. With our expanded pre-hospital education centre, our training offering has opened up within our region. But virtual reality means we can reach many more clinicians and potentially impact the lives of many more patients.

Nothing can ever fully replicate that moment a scalpel is in your hand at the scene of an emergency and a person’s life depends on the accuracy of your actions. But, with these new immersive lessons added to the range of other realistic training we offer, our crew will be as prepared as it’s possible to be. To return to my gaming analogy: it’s a definite ‘level up’.