title: A Serious Game for Massive Training and Assessment of French Soldiers Involved in Forward Combat Casualty Care (3D-SC1): Development and Deployment.
abstract: BACKGROUND
  The French Military Health Service has standardized its military prehospital care policy in a ''Sauvetage au Combat'' (SC) program (Forward Combat Casualty Care). A major part of the SC training program relies on simulations, which are challenging and costly when dealing with more than 80,000 soldiers. In 2014, the French Military Health Service decided to develop and deploy 3D-SC1, a serious game (SG) intended to train and assess soldiers managing the early steps of SC.
  
  
  OBJECTIVE
  The purpose of this paper is to describe the creation and production of 3D-SC1 and to present its deployment.
  
  
  METHODS
  A group of 10 experts and the Paris Descartes University Medical Simulation Department spin-off, Medusims, coproduced 3D-SC1. Medusims are virtual medical experiences using 3D real-time videogame technology (creation of an environment and avatars in different scenarios) designed for educational purposes (training and assessment) to simulate medical situations. These virtual situations have been created based on real cases and tested on mannequins by experts. Trainees are asked to manage specific situations according to best practices recommended by SC, and receive a score and a personalized feedback regarding their performance.
  
  
  RESULTS
  The scenario simulated in the SG is an attack on a patrol of 3 soldiers with an improvised explosive device explosion as a result of which one soldier dies, one soldier is slightly stunned, and the third soldier experiences a leg amputation and other injuries. This scenario was first tested with mannequins in military simulation centers, before being transformed into a virtual 3D real-time scenario using a multi-support, multi-operating system platform, Unity. Processes of gamification and scoring were applied, with 2 levels of difficulty. A personalized debriefing was integrated at the end of the simulations. The design and production of the SG took 9 months. The deployment, performed in 3 months, has reached 84 of 96 (88%) French Army units, with a total of 818 hours of connection in the first 3 months.
  
  
  CONCLUSIONS
  The development of 3D-SC1 involved a collaborative platform with interdisciplinary actors from the French Health Service, a university, and videogame industry. Training each French soldier with simulation exercises and mannequins is challenging and costly. Implementation of SGs into the training program could offer a unique opportunity at a lower cost to improve training and subsequently the real-time performance of soldiers when managing combat casualties; ideally, these should be combined with physical simulations.
authors.affiliation: Percy Military Teaching Hospital, Department of anesthesiology and intensive care, French Military Health Service, Clamart, France. pasquier9606@me.com.
authors.forename: Pierre
authors.identifier: http://orcid.org/0000-0003-2337-7874
authors.initials: P
authors.lastname: Pasquier
authors.forename: Stéphane
authors.identifier: http://orcid.org/0000-0001-5149-5363
authors.initials: S
authors.lastname: Mérat
authors.forename: Brice
authors.identifier: http://orcid.org/0000-0002-2571-7855
authors.initials: B
authors.lastname: Malgras
authors.forename: Ludovic
authors.identifier: http://orcid.org/0000-0001-8944-3593
authors.initials: L
authors.lastname: Petit
authors.forename: Xavier
authors.identifier: http://orcid.org/0000-0002-8926-447X
authors.initials: X
authors.lastname: Queran
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-9712-9737
authors.initials: C
authors.lastname: Bay
authors.forename: Mathieu
authors.identifier: http://orcid.org/0000-0002-7334-0132
authors.initials: M
authors.lastname: Boutonnet
authors.forename: Patrick
authors.identifier: http://orcid.org/0000-0001-8021-9149
authors.initials: P
authors.lastname: Jault
authors.forename: Sylvain
authors.identifier: http://orcid.org/0000-0001-8345-1058
authors.initials: S
authors.lastname: Ausset
authors.forename: Yves
authors.identifier: http://orcid.org/0000-0001-9861-4825
authors.initials: Y
authors.lastname: Auroy
authors.forename: Jean Paul
authors.identifier: http://orcid.org/0000-0002-5786-1181
authors.initials: JP
authors.lastname: Perez
authors.forename: Antoine
authors.identifier: http://orcid.org/0000-0002-6877-4008
authors.initials: A
authors.lastname: Tesnière
authors.forename: François
authors.identifier: http://orcid.org/0000-0003-4629-9282
authors.initials: F
authors.lastname: Pons
authors.forename: Alexandre
authors.identifier: http://orcid.org/0000-0001-6585-6270
authors.initials: A
authors.lastname: Mignon
keywords: assessment; care under fire; education; forward combat casualty care; interdisciplinary collaboration; medical simulation; serious games; simulation; training; virtual simulation