It’s All about Saving Lives: Towards a Virtual Learning

Environment for the Rescue Chain

Caroline Ressing, Anna Zeuge, Andreas Weigel and Bjoern Niehaves

Institute of Information Systems, University of Siegen, Kohlbettstrasse 15, Siegen, Germany

Keywords: Rescue Chain, Virtual Reality, Design Science Research Methodology, Competencies Development.

Abstract: Simulating road accidents in a virtual reality (VR) environment and making the rescue chain experienceable

is valuable because it allows users to practice their behaviour and react more confidently and effectively in

an emergency. Following the Design Science Research Methodology (DSRM), we present the different steps

needed for the development of the VR demonstrator. Since the links of the rescue chain (cordon off the

accident scene, send an emergency call, provide first aid and hand over to the paramedics) will be simulated

realistically, potential first responders can practice their behaviour and learn from their mistakes. The aim is

to impart competencies sustainably and thus to save lives.

1 INTRODUCTION

Every year, approximately 1.35 million people are

killed in road traffic crashes worldwide. Between 20

and 50 million more people suffer non-fatal injuries

(Organization, 2018). In Europe an estimated 18,800

people were killed in a road crash in 2020

(Keersmaecker & Meder, 2021). The absence of first

aid was judged to have contributed to the death in 4%

of the cases (Henriksson et al., 2001). When a traffic

accident with personal injury occurs, immediate

medical care is of great importance. Other road users

are the first link in the rescue chain and thus the first

indicator of whether a person involved in an accident

will survive or not. One example is the deficiency of

oxygen. While the injured person loses consciousness

after about two minutes due to a lack of oxygen in the

brain, irreversible hypoxic brain damage occurs after

only five minutes (Lacerte et al., 2021). Mell et al.

(2017) describes that it takes 7 minutes from the time

the emergency call is made until the ambulance

arrives at the scene in urban areas. This median value

rises to more than 14 minutes in rural areas. At the

same time, every tenth patient waits almost half an

hour for the arrival of the ambulance service (Mell et

al., 2017).

To save lives, it is crucial that everyone can

provide adequate first aid and to ensure the necessary

care of the accident victims ("rescue chain")

(Pawłowski et al., 2018; Sánchez-Mangas et al.,

2010). In Germany the rescue chain thereby includes

the links: cordon off the accident scene, send an

emergency call, provide first aid and handover to the

paramedics (Deutsches Rotes Kreuz, 2020;

Johanniter, 2020). To ensure that German drivers are

prepared for emergencies, they have to attend a first

aid course to obtain their driving license (§19 FeV)

(Bundesamt für Justiz, 2010). In terms of content, the

course only briefly deals with the theory of lifesaving

and focuses on practical training, e.g., by using a

training manikin. However, the conditions of an

actual road accident differ significantly from the

training environment. In an emergency, most people

are themselves in shock, making it challenging to

ensure that accident victims receive seamless care

(Leach, 2004). Added to this are stress-increasing

factors such as time pressure, gapers, or injuries.

Digital progress and the use of interactive learning

systems can help to deepen the skills of first

responders and reduce stress. Repeated testing and

practice resulted in better retention and transfer of

knowledge compared to repeated learning (Butler,

2010). The more the student learns about the

importance of the content during the learning process,

the higher is one’s motivation. Ultimately, this leads

to easier learning of theoretical and practical material

(Garris et al., 2017; Vansteenkiste et al., 2006).

The digital technologies make it possible to

implement principles of continuous education, build

individual educational paths and organize mixed

learning (Bondarenko et al., 2021). Adding

Ressing, C., Zeuge, A., Weigel, A. and Niehaves, B.

It’s All about Saving Lives: Towards a Virtual Learning Environment for the Rescue Chain.

DOI: 10.5220/0010640402190224

In Proceedings of the 18th International Conference on e-Business (ICE-B 2021), pages 219-224

ISBN: 978-989-758-527-2

219

interactivity can improve this learning process.

Active involvement in the learning process facilitates

learning (Evans & Gibbons, 2007). The immersion

factor of VR makes interactivity even higher

(Bailenson, J. et al., 2008). In contrast to passive,

cinematic immersion, VR allows interaction with the

virtual environment, which makes it possible to

achieve a much higher intensity of immersion

(Vergara et al., 2017). VR promises practical benefits

in skill development and experiential learning

approaches in the sense that knowledge can be

practiced practically and interactively (Suh &

Prophet, 2018).

In this paper, a research project is introduced,

which aims for developing an interactive VR learning

system, to deepen the competencies of first

responders about the rescue chain in road accidents.

Following the DSRM (Peffers et al., 2007), we will

present our planned activities in order to introduce

them to international audience at an early stage. Thus,

this paper is a first step towards the development of a

VR-Demonstrator for the rescue chain.

2 RELATED WORK

In the context of technological progress, the

development of VR has opened up new possibilities

to experience virtual environments (Gleasure &

Feller, 2016). VR is a 3-dimensional computer-

generated tool that gives the user the feeling of being

present in a virtual environment (Desai et al., 2014).

The technology is based on head-mounted displays

(HMD), in which videos and images are shown three-

dimensionally on a screen integrated into the VR

glasses (Geng, 2013). The additional use of

controllers enables the user to interact with objects in

the virtual environment (Sherman & Craig, 2019).

Thus, VR offers not only immersion of vision, but

likewise of sound and tactile feedback (Desai et al.,

2014).

VR is used in many different domains, e.g.,

gamification, work, and medicine (Sherman & Craig,

2019). The environments and applications range from

relatively simple, such as the visualization of a

didactic laboratory, to highly complex, such as a

military training within virtual reality (Vergara et al.,

2017). In the context of learning, especially regarding

developing competencies, VR offers enormous

potential (Martín-Gutiérrez et al., 2017). Virtual

environments can also change social interaction

through behaviour and context and improve learning

(Bailenson, J. et al., 2008). VR can be used for

learning processes involving the development of

practical knowledge and personal competencies.

Experience-led learning is not primarily based on

cognitive learning processes, but also addresses

subjective dimensions such as experience or intuition

(Martín-Gutiérrez et al., 2017; Vakratsas & Ambler,

1999). The approach of experience-guided learning

starts with learning through sensual experience,

empathic experience, and breaks with the traditional

educational approach. Experience -led learning

highlights the reflection on theoretical knowledge of

each learning process by recognizing the independent

intelligence and practical action (Matthew &

Sternberg, 2009). VR supports experience-led

learning by enabling users to practice knowledge

practically and interactively (Dick et al., 2017).

Until now, no VR applications are known for

learning the holistic traffic accident and practising all

steps of the rescue chain. Only the step of first aid

(e.g., unconscious persons) is trained by VR

applications (dualgood, 2019) or interactive videos

(Techniker Krankenkasse, 2020).

3 METHODOLOGY

Since design science is essential to create successful

artifacts, design science research has become

increasingly important in the research field of

information systems (IS). Designers of digital

technology products play a critical role in ensuring

that their designed artifacts are beautiful and provide

value to their users (Hevner & Chatterjee, 2010). To

guide researchers who work on design science

research, Peffers et al. (2007) provide a methodology

for presenting its outcome, which is presented in

Figure 1.

Figure 1: DSRM Process Modell adapted from Peffers et al. (2007).

E-DaM 2021 - Special Session on Empowering the digital me through trustworthy and user-centric information systems

220

The advantage of Peffers et al. (2007) DSRM is

that it is consistent with previous literature, provides

a nominal process model for conducting design

science research, and provides a mental model for

presenting and evaluating design science research. In

the following, we build on the six steps of the DSRM.

We describe the problem identification and

motivation, definition of objectives of the solution,

design and development, demonstration, evaluation,

and communication of our research idea.

3.1 Problem Identification and

Motivation

The German law (§ 323c StGB) regulates: Everyone

is obliged to provide first aid (StGB, 2020). However,

many first responders are overburdened at the scene

of a road accident, and in 80% of these cases, no help

is provided. One reason is that many people are afraid

of making mistakes and fear the legal consequences.

Furthermore, the last first-aid-course often took place

a long time ago. Moreover, the conditions of an actual

accident differ significantly from the theoretical

training environment: Most people are in shock

themselves in emergencies. In addition, there may be

conditions that create unknown types of stress, such

as injuries, time pressure, and gaffers.

Existing solutions prove that VR is suitable for

teaching competencies in emergency or disaster

situations, e.g., teaching first aid for non-

professionals (4HELPVR, 2019) and rescue chains in

disaster operations for specialists (FLAME Systems

PTYLTD). However, there is no virtual training

environment that simulates the rescue chain

holistically and imparts competencies across all links.

Thus, the rescue chain can only be trained to a limited

extent, which might be insufficient considering the

extreme stress situation of an actual road accident.

Therefore, the motivation to develop another

learning platform is also based on preparing first

responders for the worst-case scenario through a

playful approach and a higher self-motivation.

3.2 Objective of Solution

The solution's objective is to develop a VR-based

learning environment, which allows users to repeat

training contents as often as they like to react more

efficiently to emergencies. Users can experiment with

objects and the environment itself and thereby gain

valuable learning experiences (Bailenson, J. N. et al.,

2008; Martín-Gutiérrez et al., 2017). The interaction

with the learning environment (e.g., applying a

bandage) and the feedback from the VR environment

(e.g., bleeding stops) can improve the learning

success. This enables users to immerse themselves in

a realistic accident, to deepen their competencies

without harming others (Naik & Brien, 2013) and to

gain the necessary self-confidence (Pulijala et al.,

2018) to apply the rescue chain in real-world settings.

In this case, i.e., learning the rescue chain within VR,

the immersion should be as high as possible so that

users do not dismiss the application or helping within

the application as a "gimmick" and they recognize the

seriousness of the situation. Thereby, classical

concepts like first aid courses are not replaced but

instead supported. The attendees of the first aid

courses are the primary target group.

3.3 Design and Development

First, we conduct a requirement analysis regarding

competence development and VR design: Which

steps and processes of the rescue chain's links are

relevant? How can these be suitably transferred to a

VR environment to convey competencies along the

rescue chain?

Furthermore, it is considered how informal or

realistic the representation must be. When the user

learns in a virtual environment that represents the

retrieval environment (environment congruence),

implementation is facilitated (Jahn et al., 2018). VR

can be used very well to create a realistic-looking

world that can be interacted with in real-time (Burdea

& Coiffet, 2003). This interaction can be with avatars

or collaborative work and cooperation between

several actors. Implications for designing an

immersive VR system suggest strengthening the

sense of embodiment and presence influences the

system's immersion and provides a more artificial or

a human avatar that influences the sense of social

presence (Kampling, 2018). The immersion within

VR is conveyed by visual aspects and reinforced by

auditory and tactile feedback (Desai et al., 2014).

How this feedback can be designed will also be part

of the design process.

A significant disadvantage, especially when VR

glasses are worn for a more extended period, is

motion sickness (Munafo et al., 2017). The effect is

caused by the fact that the input from several senses

is perfectly coordinated in the real world, while in the

virtual environment, the sense of sight is

contradictory and asynchronous to the rest of the

input (Lewis, 2015). Due to motion sickness, in

addition to the type of VR application, the length of

time the user spends in the virtual environment must

be considered.

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221

To test the conditions as mentioned earlier,

interviews will be conducted with experts (e.g.,

paramedics, fire brigade, doctors or driving

instructors) and future users (i.e., drivers or first aid

course students). These interviews are conducted

before the implementation of a VR environment.

Here, the advantages and disadvantages of existing

concepts such as learning videos or classic training

will also be asked and taken up in design

implementation. In addition, workshops will be held

to reflect on the results and develop concrete

scenarios (e.g., rollover car) with experts. These

results will be compared to the classic driver training.

The outcome will be a technical concept (guidelines

for the competence development of rescue chain) and

a technological concept (guidelines for the integration

of VR).

3.4 Demonstrator

According to the technical and technological

conception, the elaborated scenarios are created as a

demonstrator. This development is done in an agile

way to create a user-oriented and at the same time

sustainable technology. Different levels of difficulty

and development stages are to be created.

Example scenario: You see a movie in VR: You

are driving on a highway. In a curve, a car appears

which has crashed into a tree. A tire blocks the

opposite side of the road. You are stopping on the

emergency lane. The accident victim sits disoriented

at the side of the road and seems to be in shock. You

recognize a bleeding head injury. Now you have to

take action - you are the first responder! You can

move freely in the virtual environment and move

objects (e.g., the tire). What will you do first? Will you

put on a safety vest? Do you remove the tire from the

road? Do you provide first aid? Do you call the

rescue service?

For the scenario to be successful, the subjects

must make independent decisions. This means that

the test persons (e.g., first aid students) decide which

step to take first, and the system then gives them a

reaction, a feedback (decision-reaction chain). An

example is when the road is not secured quickly, cars

pass the test persons quickly or a rear-end collision

occurs. The time component will play a role regarding

the reaction chain. The total time per scenario will

only play a subordinate role. This is done about the

learning success, to be able to carry out the scenario

to the end. For example, if the decisions are correct,

but the test persons have problems with the controls

in VR. Such initial problems should not reduce the

learning success.

3.5 Evaluation

The VR demonstrator will be continuously evaluated.

This evaluation will explore to which extend the

demonstrator can be used for competence

development of the rescue chain. In the context of

quality assurance of the VR demonstrator a formative

evaluation is aimed, which continuously checks

technological (e.g., usability tests) and technical

aspects (e.g., integration of different links).

Formative evaluation is a study approach that is often

key to success, interpretation, and replication of

outcome (Stetler et al., 2006). Besides, the

development is to be discussed and reflected, e.g., in

workshops with experts. The objective is an iterative

development based on the results of the evaluation.

3.6 Communication

Archer (1984) and Hevner et al. (2004) stress that

communication is essential to diffuse the resulting

knowledge. Therefore, Peffers et al. (2007)

recommend communicating the problem and its

importance, the artifact, its utility and novelty, the

rigor of its design, and its effectiveness to researchers

and other relevant audiences, such as practitioners,

when appropriate. We are convinced that this

research idea contributes to the fact that every citizen

can fulfil one’s social responsibility to "provide

help." Thus, it is important to contact researchers and

practitioners continuously as well as at an early stage

and request feedback. This is ensured not only

through scientific implementation in papers and

journals, but also through social internet presence

such as podcast, videos, or short articles. This

feedback can contribute to the implementation and

quality of the realization.

4 CONCLUSION

This paper builds upon the DSRM and presents the

development of a VR environment that allows

practical and interactive training of the rescue chain.

Therefore, this research proposal will contribute to

theory and practice alike:

From the theoretical perspective, we want to build

up on existing research that demonstrates that VR is

suitable for developing competencies. Our

contribution will not only be to investigate how the

VR environment needs to be designed to ensure

appropriate competencies development about the

rescue chain, but rather whether VR also provides the

necessary self-confidence and self-efficacy to apply

E-DaM 2021 - Special Session on Empowering the digital me through trustworthy and user-centric information systems

222

the learned competencies in real emergencies.

Furthermore, questions are raised about design and

implementation, how close to reality does the rescue

chain need to be designed. To what extent do design

decision about presence, immersion and experiential

learning play a role in a VR environment.

Furthermore, we will also look at the acceptance of

VR in terms of considering the end user's point of

view from the very beginning. These will be

considered in the evaluation and communication.

Our research will also make critical practical

contributions. By making rescue chains

experienceable, potential first responders can practice

their behaviour interactively. They can gain

confidence in their decisions and learn from their

mistakes. The representation of the rescue chain in

VR offers the advantage that behaviour in a

dangerous situation can be tested without putting

oneself in danger (Bourhim & Cherkaoui, 2020). In

this way, more efficient learning successes should be

achieved (Greenwald et al., 2017), ensuring that users

feel well prepared for an emergency. Our solution is

intended to be made available to institutions that are

responsible for teaching competencies in the areas of

driving safety (e.g., driving schools or driver safety

training) and first aid (e.g., German Red Cross,

Johannite, or Malteser). Here, the design will also be

evaluated through expert interviews of these groups.

Overall, this research project should contribute to

save lives.

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