Making hospital fire safety a reality

Professor Jag Dhanda discusses the importance of offering immersive training experiences at an affordable rate and the creation of a fire safety app for NHS professionals

From immersive training solutions to medical and surgical education, rapid advancements in extended reality (XR) technologies are having a profound impact on the healthcare industry.

For those who work in healthcare, extended reality, including virtual reality (VR) and augmented reality (AR), has enabled us to push not only the boundaries of what is possible with modern medicine and science but also to transform how we train the next generation of healthcare workers. The not-for-profit initiative, Virtual Reality in Medicine and Surgery (VRiMS) was created precisely for this purpose – to be an industry changemaker in bringing extended reality to the forefront and by developing bespoke solutions that could elevate our current level of healthcare.

As a research and academic group, VRiMS creates and provides hardware and software resources through virtual reality, augmented reality, and the metaverse to aid with a new kind of immersive learning, and two years ago, as a way to kickstart this venture, we began developing a fire safety app to meet the needs of 1.3 million NHS workers who are required to undergo mandatory fire safety training on an annual basis.

The science behind VR

The fire safety app works by combining VR and AR technologies to simulate the various ways a fire could break out in a hospital setting, allowing the user to interact and respond to potential risks in a safe and secure environment.

In order to better our understanding of how to effectively conceptualise immersive simulations, we conducted a scientific evaluation of extended reality through qualitative and quantitative methods. This considered the user experience within a simulated environment, such as eye-tracking motion capture for surgical manoeuvres. For the fire safety app, we were able to combine a variety of extended reality methods, as follows:

  • Virtual Reality Six Degrees of Freedom (6DOF)
  • 360 video
  • Interactive 360 video
  • Synchronised VR

In the conventional sense, virtual reality is a digitally created world in which you have a physical presence. This computer-generated space is open for the user to move around in and interact with the environment, including using hand controllers to manipulate objects in the VR environment.

This level of interactivity enables trainers to monitor how people manage evacuations. For example, we can analyse how users cope with picking up an extinguisher, which doors to open and which not to open, and then assess their responses in terms of competencies. Collaborative training is also possible via a multi-user interface, such that two people can work together to manage a particular fire scenario. There is also scope for a third person, such as a fire officer, to watch this in real time on a screen. They can monitor how trainees interact and provide commentary.

Referred to as Six Degrees of Freedom, this technology enables learning to be as interactive and immersive as possible. But the downside of using such technology is the high cost needed to develop it, with this app simulation costing as much as £40,000. For the NHS, this is prohibitively expensive.

To mitigate these high costs, we have utilised other extended reality resources that provide the same immersive experience but on a much more affordable scale. This is where 360 video comes in. The technology uses a camera with a lens at both the front and the back, allowing users to look around but not move within the space.  Essentially, it offers a passive learning experience. The videos can be played inside a low-cost headset or directly on a mobile phone. Low-cost headsets are widely available on the market, retailing at around £30, and you can simply put the video that you want to watch in stereoscopic view and place the phone inside the headset.

360 video is a perfect example of how using extended reality methods suddenly becomes more scalable because it allows you to convert your mobile phone into a VR headset. This is far more affordable compared to a £600 headset with a simulation that costs £40,000 to make.

Another immersive technology ideal for training environments is synchronised VR. The method enables trainers to sync multiple VR headsets and manage them on a single device at the front of the classroom. All learners can watch the simulation simultaneously and be guided by the trainer to look in certain directions, pick out certain objects such as a fire extinguisher, look towards other people in the simulation, see what they are doing or how they are managing a situation, and more. The trainer is able to control what is being watched, and also add a narrative over that video, all through a tablet.

The Fire Safety Training app

Funded by Health Education England (HEE), the Fire Safety Training app was developed specifically for the NHS and adopts some of the VR and AR technologies discussed above. As part of the app, we built four different scenarios to simulate the multiple ways that staff might need to respond to a fire emergency in a hospital setting:

  • Toaster fire
  • Fire behind a door
  • Evacuation
  • Using an extinguisher

Each of these simulations requires the learner to use an object related to that scenario, such as a fire blanket or a fire extinguisher. The user can pick up an object and use it as if it were in their hand, creating a fully immersive experience for the learner.

VRiMS worked alongside fire safety officers from West Sussex Fire and Rescue Service (WSFRS) and Cineon (VR). Our intention was to make the simulation as accurate and as credible as possible, so the 6DOF simulation created is a replica, or digital twin, of a ward in an NHS hospital – Queen Victoria Hospital in East Grinstead.

The starting point for developing the app was 360 video technology. We began by filming a scenario of a fire that had been storyboarded by the WSFRS. Fire officers played the roles of patients and staff, and the 360 video shows a fire emergency from start to finish, with a fire propagation demonstration. It begins by detecting a fire, then calling the fire brigade, and finally, dealing with the emergency.

The video allows you to look left and right and get a different view, and while the simulation assumes a passive experience, we were able to take it one step further by using software to add in interactive hotspots. These hotspots can be added throughout the 360 video, allowing the learner to answer questions and get visual cues on what is happening throughout the simulation.

They also allow you to change the narrative because a particular fire protection officer, for example, might have their own perspectives on priorities even though there is a standardisation of what has been taught. Training somebody to add these hotspots is relatively quick and easy, so what we end up with is something that is a passive video and low in cost to build, but its interactivity makes it a fully immersive experience. There are also action points throughout the scenarios, with each action point leading to a choice of options. The learner must correctly identify the correct option to safely complete the scenario.

The collaboration between the NHS and fire officers enabled us to develop the app to a high standard, as we were able to accurately incorporate the legal requirements of fire safety. The fire service also advised on having interactive hotspots in key areas so that staff were aware of what to look for in a real emergency. All of this ensured a fully immersive experience for the user.

Our purpose with the simulation was to mimic the idea of a user being in that fire situation, forcing them to actively engage, think on their feet, and deal with the situation at hand. Patient safety is paramount as is ensuring that the correct procedure has been followed.

Each simulation also ends with a quiz, to test that the immersive hotspots have been read and that the appropriate equipment was correctly used. It will also show users the order in which they completed the simulation and what they could have done differently. To encourage users to make the most of the app, we also created a simple guide on how to wear and use VR headsets, including what triggers to use and when and how to move around.

From fire safety training to global health

Using immersive technologies in training offers students a new approach to problem-solving, allowing them to apply critical thinking in a more engaged and immersive way. It also encourages us to come up with innovative solutions to make training a more engaging experience. Ultimately, XR offers a different way of teaching that is more than the conventional sitting in front of a lecture. There is really good evidence that cognitive immersive approaches are a much better way at skills acquisition, known as cognitive offload. You can park a bit of space in your brain to be able to acquire new skills, and by using this XR approach you are more likely to remember it when compared with somebody giving a lecture with a video.

While such resources are ideal for NHS environments, extended reality can also play a significant role in elevating global health, with the primary focus of VRiMS being on medical and surgical education.

As a professor of surgery, specialising in complex facial reconstructive surgery, and a professor of extended reality and medicine, I firmly believe that XR will have a vital role to play in training the next generation of healthcare workers.

A focal part of our mission has been to develop training resources for low to middle-income countries utilising XR technologies. We firmly believe that training should be made accessible at an affordable rate, with our goal to deliver medical and surgical education at scale. VRiMS has already delivered training courses around the world, including Brazil and Mexico, with five training centres currently being set up in Africa. Whether it be offering fire safety training solutions or elevating healthcare around the world, the social impact that XR technology could have is profound. This is the future of healthcare and training as we know it.

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Professor Jag Dhanda is the Director of Virtual Reality in Medicine and Surgery (VRiMS)