Immersive virtual reality-based training improves response in a simulated operating room fire scenario

Abstract

Background

SAGES FUSE curriculum provides didactic knowledge on OR fire prevention. The objective of this study is to evaluate the impact of an immersive virtual reality (VR)-based OR fire training simulation system in combination with FUSE didactics.

Methods

The study compared a control with a simulation group. After a pre-test questionnaire that assessed the baseline knowledge, both groups were given didactic material that consists of a 10-min presentation and reading materials about precautions and stopping an OR fire from the FUSE manual. The simulation group practiced on the OR fire simulation for one session that consisted of five trials within a week from the pre-test. One week later, both groups were reassessed using a questionnaire. A week after the post-test both groups also participated in a simulated OR fire scenario while their performance was videotaped for assessment.

Results

A total of 20 subjects (ten per group) participated in this IRB approved study. Median test scores for the control group increased from 5.5 to 9.00 (p = 0.011) and for the simulation group it increased from 5.0 to 8.5 (p = 0.005). Both groups started at the same baseline (pre-test, p = 0.529) and reached similar level in cognitive knowledge (post-test, p = 0.853). However, when tested in the mock OR fire scenario, 70% of the simulation group subjects were able to perform the correct sequence of steps in extinguishing the simulated fire whereas only 20% subjects in the control group were able to do so (p = 0.003). The simulation group was better than control group in correctly identifying the oxidizer (p = 0.03) and ignition source (p = 0.014).

Conclusions

Interactive VR-based hands-on training was found to be a relatively inexpensive and effective mode for teaching OR fire prevention and management scenarios.

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Acknowledgements

The authors acknowledge the valuable inputs from the SAGES FUSE committee during the various phases of the development of the VEST OR fire module, providing questionnaire to be used for the study and sharing power point presentation materials.

Funding

This work was supported by funding from NIH/NIBIB R01 EB014305.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ganesh Sankaranarayanan.

Ethics declarations

Disclosures

Dr. Jones is a consultant for Allurin, a Intragastric balloon company. Drs. Sankaranarayanan, Dorozhkin, Olasky, Chauhan, Fleshman, Scott, De and Ms. Wooley and Hogg have no conflict of interest or financial ties to disclose.

Additional information

Presented as a poster at the SAGES 2017 annual meeting.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MOV 273204 KB)

Supplementary material 1 (MOV 273204 KB)

Appendix

Appendix

Test questionnaire

  1. 1.

    Which of the following is true:

    1. a.

      Between 550 and 650 OR fires occur each year

    2. b.

      Each year 20–30 OR fire-related injures result in disfiguring or disabling outcomes

    3. c.

      One of 11 priority safety topics identified by AORN Presidential Commission on Patient Safety

    4. d.

      All of the above

  2. 2.

    Which of the following cannot contribute to an OR fire:

    1. a.

      Nitrous oxide (N2O) source

    2. b.

      Surgical drape

    3. c.

      Argon (Ar) source

    4. d.

      Fiber optic light

  3. 3.

    The ‘C’ in the RACE acronym stands for:

    1. a.

      Coordinate

    2. b.

      Confine

    3. c.

      Coagulate

    4. d.

      Clear

  4. 4.

    Which of the following should be avoided:

    1. a.

      Placing electrosurgical electrodes in a holster when not in active use

    2. b.

      Activating the ESU unit only when the active tip is in view

    3. c.

      Making the surgeon aware of open O2 use

    4. d.

      Placing rubber catheter sleeves over electrosurgical electrodes before use

  5. 5.

    Which of the following cannot contribute to a higher value of the Silverstein/Christiana Fire Risk Assessment Score:

    1. a.

      Surgery above the xiphoid

    2. b.

      Alcohol based skin prep

    3. c.

      Available ignition source

    4. d.

      Open oxygen delivery system

  6. 6.

    Which of the following is not true with regards to explosions in the operating rooms:

    1. a.

      Reduced significantly from the era of ether and cyclopropane anesthesia prior to the 1970s

    2. b.

      Can be caused by unprepped bowel and associated hydrogen-air-methane mix

    3. c.

      Mannitol should be used for bowel preparation prior to surgery to reduce the methane production

    4. d.

      Nitrous oxide usage enhances the risk for the formation of potentially combustive combination of gases

  7. 7.

    Which of the following is not true for surgical drapes selection:

    1. a.

      Oxygen Index (OI) is a measure of drape flammability

    2. b.

      Woven cotton towels have low oxygen index

    3. c.

      Drapes with high OI do not pose any fire hazard

    4. d.

      Polypropylene is a safer material option for surgical drapes

  8. 8.

    As a laparoscopic nephrectomy is beginning, the surgical drapes catch fire from the fiber optic light cable that was turned on. The immediate next step is:

    1. a.

      Pull the fire alarm and activate a code red

    2. b.

      Stop flow of all airway gases and remove the endotracheal tube

    3. c.

      Extinguish the fire with the fire extinguisher

    4. d.

      Remove burning and burned materials from the patient

  9. 9.

    Regarding fire safety in the operating room:

    1. a.

      If possible, 100% oxygen should be avoided during head and neck procedures

    2. b.

      During an open tracheostomy, electrosurgery should be used when entering the airway to minimize bleeding

    3. c.

      The light source should be turned on before the fiber optic cable is connected to the laparoscope

    4. d.

      The surgical drapes should be applied before the skin prep has dried

  10. 10.

    While performing an open tracheostomy with a monopolar device, there is a fire in the airway. What is the sequence of events that should subsequently follow:

    1. a.

      III, II, IV, I

    2. b.

      I, IV, III, II

    3. c.

      III, IV, II, I

    4. d.

      II, III, IV, I

      1. i.

        Pull the fire alarm and activate a code red

      2. ii.

        Stop flow of all airway gases and remove the endotracheal tube

      3. iii.

        Remove burning and burned materials from the patient

      4. iv.

        Extinguish the fire with the fire extinguisher

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Sankaranarayanan, G., Wooley, L., Hogg, D. et al. Immersive virtual reality-based training improves response in a simulated operating room fire scenario. Surg Endosc 32, 3439–3449 (2018). https://doi.org/10.1007/s00464-018-6063-x

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Keywords

  • Immersive VR
  • VR training
  • Simulation training
  • OR fire management