Interactive Trauma Trainer
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The Interactive Trauma Trainer (ITT) was the result a 6-month project commissioned by the UK’s Human Factors Integration Defence Technology Centre, the aim of which was to demonstrate two key issues in the field of Human Factors Integration for synthetic or virtual environments. Firstly the importance of the early application of human factors task analysis techniques, as demonstrated successfully in the past with such Virtual Reality (VR) and simulation projects as the minimally invasive surgical trainer, MIST and part-task VR trainers for both the Royal Navy (gunnery, submarine training) and Royal Air Force (helicopter rear-door crew training). Secondly, to demonstrate the use of games engine technology to deliver useable, affordable, accessible and distributable real-time interactive 3D training content at a level of interactive fidelity appropriate to the needs of the end user. The ITT was developed exclusively for the Defence Technology Centre by the TruSim Division of Blitz Games, a leading independent UK games developer.
The Royal Centre for Defence Medicine (RCDM) is a long-established branch of the Armed Forces that has, for some time now, been viewing developments in synthetic environments/VR from a distance. However, recent world-wide events have highlighted an urgent need to develop low-cost, distributable training scenarios to help prepare trainee battlefield surgeons to make timely, life-saving decisions and to provide “refresher” training for specialist surgeons. These surgeons may well end up practising in unfamiliar contexts, such as trauma and emergency medicine, treating military personnel and civilians alike, with the additional stress of the conflict environment.
Working as a close collaborative team, the project commenced with a focused task analysis session involving the HFI DTC and RCDM. For logistical reasons, this analysis took place in the Johannesburg Central Morgue – a venue frequented by UK defence surgeons for a variety of reasons, including the “availability” of battlefield-like wounds and unhindered access to cadavers. The task selected for study and implementation related to a “zone 1” neck fragmentation wound, causing pulsatile haemorrhage, tracheal collapse and rapid patient decline. Interventional endotracheal intubation and cricothyroidotomy procedures using a cadaver were filmed and analysed, concentrating on graphical fidelity requirements, future training content and interactive styles (i.e. hands-on vs. animated sequences). Additional patient preparation and handling analyses were conducted during field trials with the 33 Field Hospital.
One of the early decisions made on the basis of interaction with, and performance analysis of RCDM subject matter experts was that the ITT was not destined to become a surgical skills trainer (such as MIST product). Rather than replicate basic surgical handling skills the user would already possess (e.g. instrument usage), the trainer would enhance the decision-making skills on the part of the surgeon – the casualty’s life would be lost within 5-6 minutes if appropriate decisions were not taken and relevant procedures applied. Consequently the ITT not only exploits powerful games engine software technology, it also exploits a typically simple gaming interface – mouse control for viewpoint change, option selection and instrument acquisition. The human factors analysis helped to define the end shape and form of the ITT, applying high fidelity effects only where they would add value to the surgeon’s task and ensuring that tasks normally requiring high dexterity inputs with high quality haptic feedback on the part of the user (e.g. use of laryngoscope, stethoscope, intubation tubes, Foley’s Catheter, etc) were committed to clear and meaningful animation sequences, rather than expect the surgical users to interact via a complex input-output device. The patient’s behaviour throughout is designed to help cue appropriate decisions. For example, the casualty can be given a Glasgow Coma Scale (GCS) rating on the basis of his motor, verbal (utterance) and spontaneous eye movement capabilities. The end user’s performance is scored on the basis of applying the right decisions at the right time – a summary chart is presented at the end of the trial indicating the decision sequence, the timing “window of opportunity” to make the decision and the actual decision time taken.
