title: [A new age of mass casuality education? : The InSitu project: realistic training in virtual reality environments].
abstract: BACKGROUND
  Chief emergency physicians are regarded as an important element in the care of the injured and sick following mass casualty accidents. Their education is very theoretical; practical content in contrast often falls short. Limitations are usually the very high costs of realistic (large-scale) exercises, poor reproducibility of the scenarios, and poor corresponding results.
  
  
  OBJECTIVE
  To substantially improve the educational level because of the complexity of mass casualty accidents, modified training concepts are required that teach the not only the theoretical but above all the practical skills considerably more intensively than at present. Modern training concepts should make it possible for the learner to realistically simulate decision processes. This article examines how interactive virtual environments are applicable for the education of emergency personnel and how they could be designed.
  
  
  METHODS
  Virtual simulation and training environments offer the possibility of simulating complex situations in an adequately realistic manner. The so-called virtual reality (VR) used in this context is an interface technology that enables free interaction in addition to a stereoscopic and spatial representation of virtual large-scale emergencies in a virtual environment. Variables in scenarios such as the weather, the number wounded, and the availability of resources, can be changed at any time. The trainees are able to practice the procedures in many virtual accident scenes and act them out repeatedly, thereby testing the different variants.
  
  
  RESULTS
  With the aid of the "InSitu" project, it is possible to train in a virtual reality with realistically reproduced accident situations. These integrated, interactive training environments can depict very complex situations on a scale of 1:1. Because of the highly developed interactivity, the trainees can feel as if they are a direct part of the accident scene and therefore identify much more with the virtual world than is possible with desktop systems.
  
  
  CONCLUSIONS
  Interactive, identifiable, and realistic training environments based on projector systems could in future enable a repetitive exercise with changes within a decision tree, in reproducibility, and within different occupational groups. With a hard- and software environment numerous accident situations can be depicted and practiced. The main expense is the creation of the virtual accident scenes. As the appropriate city models and other three-dimensional geographical data are already available, this expenditure is very low compared with the planning costs of a large-scale exercise.
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Geb. 57, Homburg/Saar, Deutschland. dominik.lorenz@uks.eu.
authors.forename: D
authors.initials: D
authors.lastname: Lorenz
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Geb. 57, Homburg/Saar, Deutschland.|Notfalltrainings- und Simulationszentrum der Universität des Saarlandes an der Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Homburg, Homburg/Saar, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Armbruster
authors.affiliation: Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Vogelgesang
authors.affiliation: Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI) GmbH, Saarbrücken, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Hoffmann
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Geb. 57, Homburg/Saar, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Pattar
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Geb. 57, Homburg/Saar, Deutschland.|Notfalltrainings- und Simulationszentrum der Universität des Saarlandes an der Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Homburg, Homburg/Saar, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Schmidt
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Geb. 57, Homburg/Saar, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Volk
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421, Kirrberger Straße, Geb. 57, Homburg/Saar, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Kubulus
mesh_terms: D000059:Accidents; D002959:Civil Defense; D002983:Clinical Competence; D003196:Computer Graphics; D003198:Computer Simulation; D004630:Emergencies; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents; D014584:User-Computer Interface; D014887:Weather
keywords: Chief emergency physician; Emergency physician education; MCI-training; Mass casualty incident (MCI); Virtual reality