The Impact of the Addition of a Virtual Reality Trainer on Skill Retention of Tourniquet Application for Hemorrhage Control Among Emergency Medical Technician Students: A Pilot Study

Abstract

Introduction: Trauma is a leading cause of preventable death in the United States. Emergency Medical Technicians (EMTs) often arrive first at the scene of traumatic injuries to perform life-saving skills such as tourniquet placement. While current EMT courses teach and test tourniquet application, studies have shown efficacy and retention of EMT skills such as tourniquet placement decay over time, with educational interventions needed to improve retention of skills.Methods: A prospective randomized pilot study was conducted to determine differences in retention of tourniquet placement among 40 EMT students after initial training. Participants were randomly assigned to either a virtual reality (VR) intervention or a control group. The VR group received instruction from a refresher VR program 35 days after initial training as a supplement to their EMT course. Both the VR and control participants' tourniquet skills were assessed 70 days after initial training by blinded instructors.Results: There was no significant difference in correct tourniquet placement between both groups (Control, 63% vs Intervention, 57%, p = 0.57). It was found that 9/21 participants (43%) in the VR intervention group failed to correctly apply the tourniquet while 7/19 of the control participants (37%) failed in tourniquet application. Additionally, the VR group was more likely to fail the tourniquet application due to improper tightening than the control group during the final assessment (p = 0.04). Conclusion:In this pilot study, using a VR headset in conjunction with in-person training did not improve the efficacy and retention of tourniquet placement skills. Participants who received the VR intervention were more likely to have errors relating to haptics, rather than procedure-related errors.

Use of Cognitive Aids to Augment Point of Care Hemorrhage Control Skills in Laypersons

“…The specific type of instructional aid, the method of delivery, and how participants are familiarized (“primed”) with the aid are essential elements that may influence the efficacy of an aid in an emergency scenario. 6,8,16−18 The current work found that the most optimal format of an instructional aid for tourniquet performance is for bystanders who had attended the B-Con class (OR, 12.67; P = 9.3 × 10 −11 ), used a visual-audio aid (OR, 1.96; P = 0.04), and were primed on that aid before using it (OR; 2.23; P = 0.01). Specifically, in this format with a visual-audio aid, 77% of laypersons could correctly apply a tourniquet with a third of the number of errors.…”

“…Previous work suggests a likely critical threshold where skill retention declines at 6 mo, although incorporating an aid can revive these skills. [6][7][8]18 If this aid is trained on immediately after the completing a technical B-Con course, we hypothesize that retention skills can be further improved by coupling hands-on practice of hemorrhage control skills with cognitive aid familiarity. Future work in this context is necessary moving forward.…”