Paramedic virtual reality check: Don’t expect rapid prehospital adoption of VR technology
Augmented reality, with heads-up display devices and conductive swath devices, has the potential to improve patient assessment and care
Early adoption of new and emerging technologies is a trend for many EMS professionals. There are times when those technologies fit into the gap perfectly, such as WiFi and Bluetooth for EKG transmissions or tablets for documentation. There are other times when employing the latest technologies is about trying to appear cutting edge, about trying to fit the square peg into the round hole such as using Twitter as a substitute for a mobile data terminal messaging incident locations to responding crews.
Such is the case with virtual reality.
Virtual reality technology immerses the user in an environment other than their actual surroundings through sight and sound. The user's ability to interact and manipulate in this alternate environment is the key ingredient that defines virtual reality.
The concept of virtual reality has been around since the 1930s and emerged with concrete applications in the early 1980s. The technology remained limited to research labs though it was popularized through science fiction media and popular culture in the 1990s and 2000s.
Recently, virtual reality has experienced a resurgence as the technology has matured enough to become a consumer product. Hardware and software for virtual reality is primarily geared for media consumption and use within the video gaming community.
Despite this progress, the prospect of paramedics utilizing virtual reality in their day-to-day functions remains bleak. There is no practicality to a paramedic visiting a patient through virtual reality. If you were to go to such lengths of deploying the technology, then it would likely be more efficient to utilize a physician with their larger scope of practice.
There are a number of programs around the country that utilize paramedics as the in-real-life physical provider of care before, during and after an assessment from a physician using telemedicine tools. These community paramedicine programs use sight and sound to provide the physician with the setting and general impression of a patient, while the on-scene provider relays tactile information gained from any directed physical assessment. Virtual reality technologies are extensions of these mobile integrated health programs, creating greater demand for paramedics to deliver the actual physical treatment on scene.
Virtual reality for EMS training
While deployment of virtual reality in the field is impractical, there are some places in EMS where it can help bridge a gap. The most effective area is likely simulation training. While many institutions utilize hands-on practical sessions to help students develop skills, the actual environments used are often idealized and not representative of the reality where patient assessment and treatment skills will be utilized.
Even absent smell, touch and taste, students using virtual reality for scene simulation could be exposed to more realistic environments in which they'll eventually find themselves outside the classroom. Darkened bedrooms infested with insects, overturned vehicles and industrial facilities are some of the environments that may be more easily created for student paramedics using virtual reality than those created physically in a school or training center.
Augmented reality for EMS training
Augmented reality has long been considered the halfway point on the road to virtual reality. Augmented reality blends the user’s actual environment with computer generated and interactive elements to allow added functionality like physical manipulation.
The technological requirements for augmented reality are considerably less than for virtual reality, allowing for quicker hardware and application development. Products for augmented reality, like Google Goggles and Yelp’s Monocle feature, have been available since 2011. The Monocle lets Yelp users view nearby businesses with the camera on their smartphone.
The summer of 2016 Pokemon Go gaming craze, which has resulted in additional ambulance runs, is another recent example of augmented reality already being used in the real world.
Wearable devices for augmented reality have been commercially available since 2013, allowing both further development and proof of concept in health care. Google’s Project Glass and Microsoft’s HoloLens are examples of commercially available augmented reality devices.
Augmented reality devices, specific to paramedic use, are likely to become available as wearable pieces of equipment, a heads-up-display (HUD) and a conductive swath or glove.
The HUD will most likely take a physical form similar to current eye-protection goggles or glasses. A paramedic would be able to see a variety of information including GPS directions, biometric readings from a patient and even treatment protocols that progress step by step as the paramedic completes them in the field. The HUD information would be overlaid upon the paramedic’s actual surroundings.
The HUD could help the paramedic with other tasks like walking through a dark or dimly lit room by providing digitally enhanced night-vision or acting as a conduit for translation services to overcome a language barrier. By tying into or connecting HUD devices worn by other members of the service, the HUD could also provide an operational overview at mass casualty incidents, transmit alarms when the user is in danger or has become injured and direct teammates to their side quickly. Ultimately, a HUD device might be capable of providing eyes and ears to a physician assessing a patient with a telemedicine system.
The conductive swath that the paramedic would wear on their forearm, upper leg or a glove on their hand would provide both an input link to the ePCR system and a second screen for the mobile data terminal. When viewing the swath, the augmented reality system would overlay patient or protocol information and virtual input buttons for navigating the operating system.
Diagrams, maps and a patient’s electronic medical record might be viewed through a conductive swath without causing disorientation for the user or completely eclipsing their surroundings from view. Overlaying a keyboard on the swath would provide a method for non-verbal communication with the command center, easy access to document findings or allow a medic to perform quick searches for relevant information regarding a patient's condition. Because it would be constructed of conductive materials, the swath could also be used to secure signatures from patients for refusals of care or acceptance of the patient by a nurse at a receiving facility.
Performing gestures with a glove, which includes a conductive swath, could provide similar access to system features. Additionally, the glove might contain tools that assess a patient’s biometric information by directly displaying it in the HUD and saving the information in the patient’s medical record. Oxygen saturation, pulse rate, skin temperature and carbon monoxide oximetry are some of the measurements that might be possible with integrated sensors.
As virtual reality and augmented reality continue to develop, we will undoubtedly see them gain traction in the consumer marketplace before being adapted to health care, specifically the type of mobile healthcare that EMS personnel provide.
It is vital we don't simply adopt expensive and impractical technologies of the moment for the sake of their novelty. Instead, we must integrate what we've learned from mistakes of the past with practical and proven applications of new technologies to provide positive patient outcomes and provider work experiences.