The Golden Hour is a experiential first person narrative VR solution for Indian EMT's (emergency medical technicians) working in highly critical field situations. It focuses on creating realistic training environments to help prepare them to maintain composure and increase efficiency of procedures administered. The solution revolves around motivating accurate choices and putting to test skills of situational awareness, problem-solving, interpersonal skills. The solution helps put these skills to context in order to be prepared and confident before being plunged into the actual scenario. The aim is to help the EMT increase his self-image, with boosted confidence to understand the tangible and intangible portions of the curriculum along with faster acquisition of knowledge. This is to make paramedics confident and composed of their actions to correctly administer spontaneous thinking and procedures.
The solution is based on choice-based outcomes as every course of action taken on the field is crucial to the care and final status of the patient. The intervention utilises psychological and situational training using VR that occurs post the theoretical and practical training on mannequins. Appropriate environments were created and connected by a cohesive storyline which was shown through VR storyboards and low fidelity prototypes. The concept aims on building self-image by signifying their power in the situation through a 'light' everywhere they go. It includes instructional design- combining education, psychology and communication to create an effective training program. It uses social feedback in the form of acknowledgement from doctor and patient's family and performance evaluation to understand their strengths and weaknesses. The EMT would be going through a series of tasks that define the experience to aid a patient victim of a road accident. The high-fidelity prototype with unity began with finding appropriate assets, skyboxes and key characters put to make the narrative more realistic. After the selection and providing characteristics to them, appropriate UI elements were designed and their interactions coded in C#. Through the process of building the high fidelity various pivot points were made to enhance the instructional design for better acquisition and application of knowledge and skills. The pivot points included- bridging the gap between theory and practical training, giving multiple options to choose from and to test decision making abilities. The unity narrative was coded to show both the positive and negative consequences of the decision taken which would reflect in the final section-debriefing evaluation.
The solution also includes a wide scope for expansion such as building more scenarios for the EMTs to work with and adding more evaluation aspects and complexity by testing skills such as teamwork. Addition of activities can also be done with more user-based actions pertaining to different emergencies. This solution could hold a great impact in strengthening the medical community by training the first responders (EMTs), cater to the mental health of medical professionals and finally creating more global scenarios to accustom the EMTs to practices and beliefs of different cultures all over the world.
The project began with mind mapping the service sector and after narrowing down to the user group of EMTs working in ambulatory services, visual storytelling and noting was done to better understand the arena. Secondary research of hospital and ambulance surveys revealed alarming statistics such as 95% of ambulances in India having untrained personnel and more than 90% of them transporting dead bodies. 50% of cases in urban India do not have prehospital care or treatment. The lack of proper training was not only having a harmful effect on the patients but the caregivers too. 75.8% of EMTs working in ambulance services had personal experience of mental health problems due to the stress of working on-field and 67% of EMTs contemplated leaving their job for the same reason. It was concluded that the current training and curriculum does not include a holistic training for all the skills expected of them such as observational, interpersonal, problem solving, composure and confidence. Working on the front lines to cater to victims of different accidents also served as a traumatic experience for them and could trigger PTSD. Competitive benchmarking of the healthcare sector revealed that companies like NHS blood identification, Johnson & Johnson surgical training and Immersive radiography by GE healthcare had utilised VR to train employees however none of them looked to cater to the particular problem of replicating situational training for the Indian context. In addition the current training programmes in India were also reviewed. They offer 3-6 months training courses to 12th graduates and provide theory and practical training on mannequins. After this the EMTs are directly posted to work on site which leads to fear of performance, stress and self-doubt among them.
After completion of the secondary research empathy interviews were conducted . Interview focus groups were divided into the user group of EMTs and stakeholder groups of doctors and family members to better understand the current scenario. It was found that the lack of training among the EMTs was also directly proportional to increase in workload and stress among doctors. Being in an Ambulance provokes panic among family members which was escalated by lack of communication on EMTs part. After the interview process journey maps were created to understand thoughts and emotions of the main stakeholders (the hospital staff, patient's family and backend process). Based on the understanding gathered from the research the following problem statement was formulated:-
"EMTs suffer from psychological stress as they are unprepared for on field crucial procedures due to a lack of situational training provided. This can be resolved by training to provide a sense of control and confidence in emergency situations"
Scenario recreation and environment stimulus were very important factors to take into consideration. A visual wall to get an understanding of what EMTs see on a daily basis and how it affects them psychologically to get a better understanding of the environment to be created. Key components were self-doubt and exhaustion, gory overwhelming environmental factors and after effects of being unable to perform on the spot. A critical decision to take was which stage of the EMT training process would the solution cater to. The intervention would have to focus on putting the learning to contextual practice to better prepare them for the environment they shall be put in.
Thus post the theoretical and practical training on mannequins the next stage would be an ideal fit for the intervention.
Our concept solution is called guiding through reinforcement. It focuses on choice-based outcomes as every course of action taken on the field is crucial to the care and final status of the patient. The concept revolves around motivating for their correct choices by putting to test skills of situational awareness, problem-solving, interpersonal skills to contextual practice.
A storyboard was created to detail out the narrative. The EMT would act as the protagonist going through a series of tasks that define the experience to aid a patient victim of a road accident. The options he selects to deal with different situational problems through the experience will be evaluated in terms of Situational Awareness, Problem Solving, and Interpersonal skills, the result of which will be presented at the end of the experience to help them understand their strengths and work to improve the rest. The aim for the solution was to help EMT increase his self-image, which boosted confidence in skills for field efficiency. The task flow is divided into 3 phases with new phase building on a skillset already taught.
Phase 1- Our onboarding experience starts by introducing the EMT to choose one of the three scenarios for training;- from flood, road accident and fire disaster . The strength he holds is signified through a 'light of power' exuded by him in the environment. Throughout the journey, he will face various milestones that can be answered by selecting an option as the experience revolves around given feedback and results based on choices made focussing on a user driven narrative. An important idea of our concept is the inclusion of 'maintaining focus through the chaos'. If the focus of the EMT shifts to the other environmental elements their intensity would be heightened through sound, while focusing on the patient at hand would lead to slightly subdued voices of the environment.
Phase 2- The user gets appreciated for his performance and gazes at different points at scene to register parts of the scenario and receives information about the options like is the site safe, no. of people hurt and the point of contact present in the scenario. Based on this the situational awareness is mapped out, and the user gets to know about the patient's background while communicating to victims family members on site. The evaluation factors at this intermediary level are mainly interpersonal skills and problem solving.
Phase 3- This phase is one of the crucial phases as it determines the assessment of patient injuries and the best course of treatment given as quickly as possible. The user instantly looks for checking vitals of the injured, and looking for signs and symptoms, in order to move the patient in an ambulance immediately. Inside the ambulance the first course of treatment is provided determining problem-solving and patient stabilisation. User then needs to provide an accurate assessment of the scene to the doctor showing communication and problem solving aptitude.
Phase 4- Debriefing occurs at the last stage where user is shown their performance outcome
Key interactive element used is the gaze and on gazing down within the comfort view user can see ground on which they can look to move. To recreate the scene of an emergency there are many key sounds in the user's immediate vicinity such as ambulance siren, family member crying, onlookers whispering, background traffic, machines beeping, dispatchers call. The sensation and perception of these environment sounds all around makes the user feel immersed and invested. The sound scape has been designed such that the concept of 'focus & out of focus' is established. When the user focuses on the patient, family member the environmental sounds reduce while they increase when we focus on the background. The sound is designed for a 3D space best heard on earphones. The characterisation of doctor, family member and narrator is done with the help of the relevant dialogue and tonality recorded for each.
An important step was then validating the project with users. UT results revealed, While the users felt immersed in the high stress environment due to the sound and visual design and understood the flow of events.
The solution as a service in the healthcare sector has great potential with key stakeholders including EMT training Institutes and Hospitals that will be instating the VR training. The key activity is to create an experience aligning with the theory and practical training of the EMTs to test their skills by putting them on field. The key value proposition of the solution is creating diverse high risk complex scenarios for EMTs to train to maintain their mental composure and efficiency when on field and afterwards.