Department of Health Promoting Science, Sophiahemmet University, Lindstedtsvägen 8, Box 5605, 114 86, Stockholm, Sweden.
AISAB Ambulance Service, Johanneshov, Region of Stockholm, Sweden.
Scand J Trauma Resusc Emerg Med. 2024 Sep 16;32(1):90. doi: 10.1186/s13049-024-01255-5.
How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality.
This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs.
RESULTS/CONCLUSION: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.
救护车临床医生（ACs）在处理大规模伤亡事件（MCI）时的处理方式对伤员至关重要，但他们的培训和学习机会很少，而且没有现实模拟培训的可能性。此外，目前还不清楚 ACs 在 MCI 期间的临床推理中会遇到哪种困境。通过虚拟现实（VR）模拟，可以系统地探索 ACs 的临床推理。因此，本研究旨在探索使用虚拟现实模拟大规模伤亡事件时救护车临床医生的临床推理。
本研究采用图表刺激回忆技术进行数据收集，作为探索性访谈研究设计进行。使用临床推理循环作为演绎矩阵进行定性内容分析。使用具有 MCI 场景的高保真 VR 模拟，符合纳入标准的参与者为 11 名资深 ACs。
结果/结论：在访谈中，所有参与者都发现了临床推理循环的各个阶段，但分析反思的丰富程度不同。当工作任务遵循特定的临床指南时，非分析性推理占主导地位，但当指南不明确或不存在时，就会出现分析性推理。使用 VR 模拟以安全和系统的方式进行行动培训和反思，并提高了 ACs 对 MCI 准备情况的自我意识。本研究增加了对 ACs 在 MCI 中临床推理的了解，以及对 VR 用于模拟培训的见解。
