There are few things in the world, if anything, that could ever prepare a person for watching a buddy’s foot get blown off by an IED. But that’s precisely the task that the British government is trying to accomplish. Before trauma medics are ever deployed to traumatic environments, it’s hoping to use the popular virtual reality gaming headset, the Oculus Rift, to give them a sense of realistic battlefield stress.
“When someone’s been hit by an explosive and the foot’s been blown off, you want to make sure the pallor on the face is correct; you want to stop the bleeding,” says Collette Johnson, a manager at Plextek, the electronics design consulting firm that worked on the project. “We wanted to make sure it was life-like, the breathing, the way you can put a tourniquet on. We needed something that made people feel like they were in the situation.”
As a result, Plextek has co-developed a battlefield simulation that takes place in a generic, sandy town, perhaps somewhere in Afghanistan. The person wearing the VR headset will hear flying bullets while entering a building, find the casualties, triage them, and then phone the medical center to take them away. But unlike VR exposure therapy, which treats veterans who have already been to war with virtual reality reenactments, the Plextek simulation aims to simulate the stress of being there for those who haven’t yet deployed.
It’s an emerging and sensitive area of research.
There’s some evidence that realistic wartime scenarios can actually help make people more resilient before they hit the front lines, says psychologist Albert “Skip” Rizzo, who works on a number of U.S. Department of Defense research projects related to virtual reality simulations and PTSD at the University of Southern California’s Institute for Creative Technologies. At the same time, he acknowledges, researchers have to be careful.
Rizzo’s simulations, for example, also run soldiers through horrible Iraq and Afghanistan narratives, but add a training session when the plot takes a dark turn.
“Within each episode, it’s sort of like instead of watching Band of Brothers on the couch, you’re in it,” he says. “And the event is actually drawn from the kinds of stories we hear from our PTSD population, the things that haunt them. The death of a child. Seeing women beaten. Seeing somebody laying in the road but not being able to go help them for fear that a bomb is attached to them.”
The important distinction in Rizzo’s simulations, he says, is that there’s a mentor character to walk the trainee through his or her response. “He’ll walk out from behind a tree in one environment. He’ll show up in the front seat of the Humvee,” Rizzo says. “And he walks up and walks you through the types of emotional resilience training activities that have been found to be beneficial.”
There hasn’t been a lot of research into what happens when you expose someone to virtual trauma without stress resilience training. One hypothesis, based on learning theory, suggests that this kind of exposure could actually prime someone to be traumatized, while another, called latent inhibition, suggests that this kind of experience could minimize a response that spirals into PTSD.
“I don’t believe that simply presenting somebody with what they’re going to face is all that helpful in and of itself,” Rizzo says. “But I believe that if you’re going to do that, it’s better to err on the ethical side of not just exposing people to these things, but giving them the tools to better deal with it if it does happen in the real world.”
Ideally, that’s what the Plextek simulation would do. But even with realistic bleeding and tissue damage, treating a wounded soldier in combat is very different from treating someone who’s just been in a car accident. Oftentimes, the medics are corps members who actually know the victim. When they’re treating the soldier, they could very well be treating a close friend, which carries a different emotional burden than treating a stranger. Witnessing someone get injured or killed, in fact, is actually a leading trauma associated with PTSD. Still, that alone doesn’t take into account the dozens of other environmental and personal risk factors that can lead to chronic post-traumatic stress.
Johnson says that her team is analyzing reactions closely to see if there are any kind of adverse results. A stressful scenario, after all, is the point of the exercise. “We want to understand how [medics] go into that situation and how they deal with increasing amounts of stress in the battlefield. We don’t have the noise that comes in, we don’t have the gunfire, we don’t have the uncertainty, but in this simulator we can put them in real stress,” she says.
There’s some preliminary evidence that the simulation really works. When one game developer virtually experienced the very realistic blood Plextek had helped design, he went white, Johnson says. Going forward, Johnson adds that the team will be making wounds look even more lifelike by superimposing photographs on top of them. But they’ll likely test that iteration with soldiers and medics who have already been on the front line.
“Some of the people who had this experience said, ‘This is really real.’ I think they were expecting much more of a gaming environment,” Johnson says. “And that was a real positive for us, because we didn’t want it to feel like a game.”