Video Games Hone Triage Skills

British video game developer creates a prototype that sharpens first responders' triage skills

by / December 18, 2008
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The video game market has stormed the U.S. like a commercial juggernaut. PricewaterhouseCoopers, a global professional services and consulting firm, estimates that consumer spending for console and handheld games will reach $11.7 billion in 2012, a noticeable increase over the $8.6 billion in 2007 the firm recorded.

This upturn means that games about shooting, beating and blowing up people are on the rise. But there's a lesser-known game genre whose chief goal is training and educating, rather than entertaining vicariously through digital violence.

TruSim, a division of Blitz Games Studios in the UK, develops serious games for the growing market of training simulations for the health-care, military and corporate arenas. The developer's latest innovation is Interactive Triage Trainer, a prototype designed to train first responders on how to prioritize casualties after a catastrophe.

A gameplay video reveals that players are transported to a city street that's been ravaged by a bomb blast. You can tell it's just a game, but the graphics are realistic enough to inform the user that this playing experience is an impressively three-dimensional rendered affair that's on par with much of what's available for the current generation of home video game consoles.

As the scenario begins, the sidewalk is a mess of broken glass, overturned chairs and wood and metal bars, and three civilians have suffered varied injuries. In the game, players move the cursor to look around the scene, but in the video the player immediately starts sorting the people who need urgent attention from those who don't. This is done by instructing everyone who is well enough to walk to go to the ambulance crews -- an action called a mobility sieve. Then the player can focus on the remaining people who are too injured to move themselves.

Players move the cursor from casualty to casualty and pick which one to examine. Randomly generated victims are dispersed with various injuries, such as exposed organs and bones, profuse nosebleeds, someone lying face up with no external injuries or deceased.

Once at a casualty, players enter "examination mode" and are offered five triage options: The player can talk to the casualty to see if she can talk back; check her airway, breathing rate or pulse rate; and perform a capillary refill check for blood flow. (In a real-world capillary refill check, a first responder holds the victim's hand up and presses a fingernail for about five seconds; the time it takes for the color to return to the flesh beneath the nail is the capillary refill time.)

When players finish the triage actions, they tag the casualty based on who needs care the most. They can label a casualty priority 1, immediate; priority 2, urgent; priority 3, delayed; or priority 4, deceased. The game scores players' decisions after they've tagged all casualties, informing them if their actions were correct for each casualty addressed.


Partners in Lifesaving

Virtual training could give first responder students a more immediate feel for actual medical emergencies than traditional training exercises where medical students pretend to be injured.

"They can't make themselves pale. They can't give themselves shallow breathing," said Jolyon Webb, an art manager for TruSim. "They can't kind of force adrenaline to their system to make them sweat. They just have to tell you that 'I'm sweaty. I'm kind of feeling very pale and faint.' With a digital character, you can actually make all of those things explicit and show them to people."

According to Webb, the idea for Triage Trainer began in 2006 as a research project commissioned in part by the UK's Ministry of Defence to train field-hospital personnel in conflict zones. TruSim worked on the game with technology partners, including Vega Group, a UK-based technology training and consulting company that's been involved with virtual academies and aviation training simulations.

Medical partners included the Manchester Royal Infirmary; the Advanced Life Support Group, a medical education charity; and ambulance authorities in northeast England.

Webb said the game would be appropriate for various medical professionals, including first responders, hospital personnel, law enforcement officials and firefighters.

The bulk of the game's development took about nine months, starting in early 2007, Webb recalled. After this period, TruSim began testing its prototype with people, including those training under the Major Incident Medical Management and Support (MIMMS) protocol for first responders. He said TruSim is compiling testing data to assess video game prototype's performance to see if it's ready to take to market, possibly internationally.

"We've not only worked with the medical experts and the training experts, but we have gone further, having produced this prototype to begin double-blind tests to see whether people actually do genuinely improve their performances in tests and [the] kind of retention with this kind of training," Webb said. He and his colleagues have been pleased with the data they've received from MIMMS training tests. "It is actually showing an improvement in retention of information from the group that did the training for the software, and also an improvement with accuracy and speed."

When TruSim decides to go to market, it could make the triage simulation available on multiple platforms, but Webb believes the PC would likely be the primary platform.

"The way we've developed it, we're kind of console-agnostic. Actually Blitz is an entertainment company [that] completely owns and develops its own engine, and the philosophy within the company is to keep things as cross-platform as possible," he said. "With the technology that we have in-house -- the Blitz engine -- it's actually possible to write a game that then delivers onto PC, Xbox 360 [or] PlayStation 3."


The Jury Speaks

But without a full release, people will have to settle for gameplay videos. A few first responder trainers in the U.S. shared their opinions of Triage Trainer after viewing Web footage of an earlier version of the current prototype.

"I thought it was probably something that would be fun for somebody to use, and it asks the user to make some decisions," said William Chapleau, a paramedic and manager of the Advanced Trauma Life Support course offered by the American College of Surgeons. "And then based on those decisions the patients were cared for appropriately or not, and I think there's a value in that."

But he thinks that value only applies if players are already being mentored in a traditional teaching environment, as likely would be the case with any triage training game.

"If you gave that game software to a policeman or a fireman who has had absolutely no medical training, they would make mistakes and then make the right choices maybe the second or third time around. But they might not know why it was the right choice," Chapleau said.

Chapleau felt the video game was realistic in its portrayal of casualties and emergencies, but Joseph Grafft, a former president of the National Association of EMS Educators, said the visuals could use an overhaul.

"The graphics I didn't really care for. It looked more like a game my kid would have," he said. "I think the graphics need to be cleaned up a little bit. Some of these cartoons and things that you see now Disney puts out, these people look real, and the graphics look graphic."

Grafft has taught first responders for more than 30 years and is a faculty member at the Metropolitan State University School of Law and Criminal Justice in Minnesota. He also said, from what he saw, the game didn't place enough emphasis on surveying the area for safety.

"There should have been a dropdown [menu] of some sort that said, 'scene safety: check scene, didn't check scene,' to be OK," he said. Students need to know how to evaluate a disaster scene for their own safety as well as those they're helping. "I think for a novice student, that's very, very important because there [are] too many first responders who are injured and killed because they didn't do a good job of looking around."


Hilton Collins

Hilton Collins is a former staff writer for Government Technology and Emergency Management magazines.