Mixed reality increases realism in training for mass casualty incidents

Fredrik Schulz's thesis shows how new virtual technology can complement traditional disaster training.

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combines real and digital environments

“My results show that mixed reality simulation training, which combines real and digital environments, is an effective and pedagogically robust method that allows emergency medical personnel to immerse themselves and prepare to handle major incidents with multiple casualties,” says Fredrik Schulz that recently received his PhD degree. He conducted his doctoral studies at the Department of Nursing and the Knowledge Centre for Disaster Medicine at Umeå University.

Major incidents often mean that available resources are insufficient relative to the number of injured. This places immense pressure on emergency responders, who must prioritize and make decisions under time constraints – situations where mistakes can have life‑or‑death consequences. Effective and realistic training is therefore essential, both for managing stress and performing critical tasks.

Previous research has shown that despite various forms of training, many professionals in emergency care feel insufficiently prepared for mass‑casualty incidents. As preparedness challenges in healthcare continue to grow, mixed reality is becoming an increasingly important tool for realistic and flexible training.

Mixed reality is a technology that combines the physical world with digital elements. Unlike virtual reality – where the user fully enters a computer‑generated environment and typically uses handheld controllers – mixed reality takes place within the real environment. Participants see and interact simultaneously with real people and virtual objects projected into the room, such as patients or accident scenarios. This allows them to move freely and collaborate as they would in real life, while encountering digital events that would otherwise be difficult or dangerous to recreate during training.

Fredrik Schulz is a registered nurse and earned a PhD at the Department of Nursing and Knowledge Centre for Disaster Medicine at Umeå University.

ImageFredrik Sundvall / FotoINorr

In his thesis, Fredrik Schulz explored how mixed reality technology can complement traditional disaster training and identified the factors that facilitate or hinder the learning process of skills required for major incidents. With this dissertation, he is among the first to study both technical (medical management) and non‑technical skills (such as communication, stress management, and situational awareness) in a larger group of participants.

Data were collected from emergency care services in several European countries using various methods, including observations during field exercises, interviews, self‑assessment instruments, surveys, and group discussions.

The results confirm that there remains a strong need for new methods that can strengthen both the practical and mental preparedness of emergency medical personnel.

One clear factor that supported learning through mixed reality was the strong sense of presence and immersion in the scenario.

“By presenting the accident scene virtually, emergency responders can practice forming an overall picture of the situation, collaborating with other actors on site, and understanding the different roles and areas of responsibility that exist during a major incident.”

At the same time, Fredrik Schulz found that increased realism does not automatically lead to better learning of technical skills.

“For mixed reality technology to reach its full potential, simulation training needs to reflect clinical practice to an even greater extent,” he says.

The hope is that the research findings will support the future development of mixed‑reality‑based training programmes in disaster medicine education and thereby strengthen emergency responders’ preparedness for future crises.