Virtual reality technology used to teach MCI scene command

Israel's national EMS organization uses virtual reality technologies to simulate MCI scenes and train any member to become a scene commander

By Eli Yaffe

Scenes of mass casualty incidents are complex and chaotic. Individuals are scattered all over the place, some even trapped under ruins or vehicles and others are panicking over the difficult sight they've just witnessed. For EMS organizations, working through the chaos and responding to such incidents smoothly, requires clear organizational rules and operation protocols.

After handling a vast amount of MCIs, and therefore finding that one of the most important things in managing a scene is saving time, Magen David Adom, Israel's national EMS organization, has found that the most efficient way to manage a MCI is by appointing the first-arriving EMT or paramedic as commanders. The scene commander is expected to quickly assess the situation at hand, take charge and report back to MDA's Command and Control Center. 

One of the most important things in managing a scene is saving time.
One of the most important things in managing a scene is saving time. (Photo/Magen David Adom)

To overcome the challenge of training a massive amount of staff to go from caregiver to scene commander within seconds, MDA leverages unique virtual reality technologies to simulate MCIs. MDA uses VR simulations in which any EMS provider can practice arriving on the scene, assessing which of the patients requires treatment most urgently, rescuing trapped individuals if necessary and beginning evacuation.

Relying on VR simulations for producing training materials for training team members is far more efficient than training them with drills and exercises. MCI training drills are costly and time consuming, especially if the intention is to train every EMT in the organization to be able to act as the incident commander.

Virtual reality simulations for EMS providers, on the other hand, are quickly produced, can simulate almost any kind of emergency — earthquake, terror attack — to the specific needs of the country/organization. VR simulations also allow for as many repetitions as the trainees need.   

Using virtual reality for MCI training

Our philosophy is that any EMS organization should leverage any means available to train its teams to provide the best emergency medicine treatment possible. Here is how virtual reality technology is used for MCI commander training.

1. E-learning techniques combined

Instructors use a combination of e-learning techniques, such as interactive slideshows, to ask students questions and receive real-time feedback. Recorded lessons and demonstrations of medical procedures are also provided. Team members are able to watch and learn from the videos.

2. Practice EMS response with virtual reality

We implement virtual reality technologies, such as "Second Life," to create simulations of mass casualty incidents and showcase EMS teams in action using avatars.

What makes VR simulations so true to reality is the fact that they're based on experiences acquired by MDA team members who've responded to mass casualty incidents such as terror attacks, building collapses and fires. This experience can be used for both educational videos and MCI simulations, where the team members are able to practice managing a scene. Once we've created these materials, team members can easily share them via their mobile phones and watch them on-the-go. Being exposed to such content on a regular basis ensures that MDA EMTs and paramedics are always trained and up-to-date.

Appoint the first arriving EMT or paramedic as incident commander

Here's why the first paramedic or EMT to arrive on scene should be appointed as the commander.

1. Efficient treatment

In order to effectively work within the chaos, it is important that the very first medical team have a qualified scene commander. This allows for all other team members to focus only on treating patients, knowing that he is in charge of managing the scene.

2. Time saving

When there's a staff member who's qualified for commanding a scene within each team, no team has to wait for a commander to arrive on the scene before beginning triage, treatment and evacuation. This allows MDA to save time and operate quickly.

3. Rapid triage

When the first person on the scene is able to command the teams efficiently, triage and prioritization of patient care happens immediately in an orderly fashion. This way, the commander is able to report accurate information back to the MDA dispatch center and the center later informs all other executives in the organization of the incident.

4. Rescue vehicle deployment

Quickly appointing a scene commander who's required to report back to the MDA Command and Control Center allows for a quick and efficient team and resource deployment. That EMT or paramedic assesses the situation, paints a clear picture of what's happening on the scene, and enables dispatchers to deploy appropriate teams and vehicles at a necessary amount. 

5. Cooperation with authorities

Based on many previous incidents of terror, Magen David Adom has learned the importance of fluent cooperation with other security and rescue forces. Having a commander on the scene as early as possible, allows MDA to provide other security and rescue forces with an accurate report of what's going on. This in turn allows for an efficient management of the complex scene, by all the security and rescue teams on site. 

To summarize, we see great importance in fully utilizing the available technology. However, it is important to state that although leveraging technology for rapid production and dissemination of educational materials is a great teaching technique, it is definitely not enough to qualify any EMT or paramedic as a scene commander. Face-to-face classes, exams and exercises are an inseparable part of the process.


About the author
Dr. Eli Jaffe, Ph.D., EMT-P, is the Director of Training, PR, Volunteer Activities, Marketing and International Relations Division, of the Israeli national EMS organization – Magen David Adom. He has published books and articles and is an authority in the fields of Emergency Medicine and Medical Management and is also one of the leading researchers in Israel in the field of volunteers and the prevention of PTSD. Dr. Jaffe is a well-known lecturer in the Israeli universities. Email:

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