Title:
Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

Abstract:
This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session.
Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed.
Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (P<0.001). The time to complete each scenario and its decrease from day 1 to day 3 were detected equally in the two groups (P<0.05).
Virtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.