Lights, Camera, Ultrasound! USU Nursing Students Train Using High Tech Simulation Theater

Military students from the Uniformed Services University (USU) underwent immersive medical team training in the university's Wide-Area Virtual Environment (WAVE), a state-of-the-art 3D immersive reality theater that simulates various scenarios, replicating environments from war zones to medical emergencies, to prepare them for real-world medical challenges and chaotic scenarios they might face during deployments.

The USU students from the Family and Women’s Health Nurse Practitioner program attended the university’s
Wide-Area Virtual Environment, or WAVE at the Simulation (Sim) Center for the first time earlier this month.
(Photo credit: Tom Balfour, USU)

October 10, 2023 by Ian Neligh

Everything started calmly enough—but by design, it was never going to last.

Two military students from the Uniformed Services University (USU) entered a room wearing high-end three-dimension (3D) glasses. Inside, they discovered they were surrounded by 3D healthcare professionals in a field hospital, tending to the wounded in the midst of a simulated battle. 

The students also found volunteers acting as patients lying on examining tables. As they rushed over to help, the rumble of chaos began to grow around them. The pop of distant gunfire grew closer and more intense.

The sound of explosions rattled around them, intensifying, and soon real smoke filled the room. Patients began screaming, more bombs went off, and the lights flickered—then went out entirely. 

And all the while, the students performed their duties, intently focused on the tasks in front of them. After all, they were being tested.

As Gen. George Patton was quoted as saying, “You fight like you train.” In this case, it could be “save lives like you train” for the students in the USU Family and Women’s Health Nurse Practitioner program. 

The USU students’ instruction took place at the university’s Wide-Area Virtual Environment, or WAVE at the Val G. Hemming Simulation (Sim) Center for the first time earlier this month. The Sim Center is headed by its Medical Director Dr. Patrick Monahan. The WAVE is an interactive immersive reality theater that drops military students into the middle of immersive virtual scenarios.

The WAVE is an interactive immersive reality theater that drops military students into the middle of interactive

and virtual scenarios. Experiences can include smoke, sound, smell and even launching foam rubble. (Photo

credit: Ian Neligh, USU)

“The WAVE is one of a kind—it’s the largest immersive virtual reality theater for medical team training anywhere in the world,” says computer scientist Dr. Alan Liu, the director of Virtual Medical Environments at the Sim Center. “Nobody else has a system that’s as large as ours. It combines standardized patients, basically live actors, with human patient simulators and virtual reality for a training environment that has an unprecedented level of reality.”

Consisting of 24 screens in an 8,000-square-foot theater projecting in 3D, the WAVE program can simulate everything from an operating room to a hyper-realistic helicopter evacuation. The room can become a war zone, a subway system, or the interior of an aircraft. Smells, temperature, smoke, and foam rubble can all be used to simulate explosions, environments, and realistic conditions.

“We can pump smoke, we can put in air cannons, there are simulated debris, simulated explosions,” Liu says. “When you combine everything, it’s going to be super realistic.”

Liu says this combination of capabilities gives the students at USU a unique opportunity to train in an environment that is as close to the operational one as possible, while still maintaining safety.

He says the goal is to help students become familiar with the types of situations and locations they might find themselves in during their duties.

“You want the first time in the field to be something that you feel that you can handle, to be something that you trained on before and something that you’re familiar with,” Liu says. “…You don’t want your first reaction to be shock because that would be time wasted and not beneficial to the patient.”

Liu adds they want the students to be able to fall back on their training—no matter how intense the situations.

“We try to make it as realistic as possible without harming anyone,” Liu says. “It’s a safe, repeatable environment for training in catastrophic events like traumatic amputations, explosions, and dealing with blast injuries.”

USU Graduate School of Nursing alumni and assistant professors, Air Force Maj. Jonathan Beatty and Air Force Maj. Kristen Kepler, spearheaded the effort to bring their students to the immersive virtual reality theater for medical team training.

Army Lt. Col. Cindy Roberts (also GSN Alumni) from Department of Military and Emergency Medicine (MEM) in the USU School of Medicine working with Air Force Col. Cynthia Shen (EM Physician), selected and spearheaded the Point of Care Ultrasound curriculum as the end training requirement for the simulated environment.

The WAVE consists of 24 screens in an 8,000-square-foot theater projecting in 3D, and can simulate
everything from an operating room to a hyper-realistic helicopter evacuation. (Photo credit: Tom Balfour, USU)

The WAVE, primarily a research facility for immersive virtual reality, was still in development during their own time as students at the university and they felt it provided a unique opportunity. Kepler says their goal is to make the training relevant for the students.

“We felt like some things would’ve been improved if we had a more realistic experience,” Kepler says. “I remember when I was a student, I heard about this WAVE trainer, and I was like, ‘Oh, I wish we could do that.’”

"As the previous Director of Operational Readiness and Family & Women’s Health KSA (Knowledge, Skills & Attributes) Lead in GSN and now Nursing Liaison in MEM, my goal was two-fold," says Roberts. "First, GSN students perform the eFAST Ultrasound Examination in an austere environment; second, assess GSN students retention of the eFAST exam at six months post training (provided by Col. Shen and other SOM faculty) based on the Army ICTL standards for 66P (or FNP)."

Roberts explains that Col. Shen was essential to co-development and project guidelines based on her POCUS experience and testing of medical students. She also provided ultrasound equipment and two enlisted servicemen as patients, while Beatty and Kepler gathered the GSN students, scheduled the event, and coordinated two GSN faculty to grade.

"Currently, the USAF and Navy does not require this training for their NPs," Roberts adds. "GSN is leading the way! In the new DHA or tri-service environment, it is imperative our NPs are operational ready to practice to the full scope of their licensure in any environment."

Beatty says the idea was to bring their students to the facility and test their point-of-care ultrasound knowledge. “We want to put them in an environment where they’re pushed to use those skills both as a refresher and to assess where they’re at,” says Beatty.

Part of the inspiration for the training at WAVE is to help get the students ready for Bushmaster, the university’s legendary practicum used to introduce students to the types of chaotic scenarios they might face in medical emergencies simulating a deployment. 

Both fourth-year medical students from the School of Medicine and second-year students from the Graduate School of Nursing learn about leadership and teamwork as they provide care to patients during mass casualty exercises, simulated mortar attacks, and simulated gunfire attacks. 

For Beatty and Kepler, WAVE was a logical step in getting their students ready for this next level of realistic training. 

“It’s very immersive… and as close as we can get to Bushmaster so they can be a little more prepared when they get there,” says Kepler.  Bushmaster is USU’s fourth-year medical field practicum and a requirement for graduation. 

Beatty echoed Kepler’s sentiments, adding WAVE was getting the students as close to the experience of a stressful combat environment as possible.

“They have no idea what they’re going to experience,” says Beatty. “So they’re going to show up, and be put into this room, a simulated environment, and told, ‘this is your patient.’ We want to see how they react to that environment.”

The experience was real enough for student Army Capt. Amanda Bischoff that it reminded her of a similar experience. 

(Photo credit: Tom Balfour, USU)

“For me, personally, having been assigned to a combat support hospital, I almost felt at home a little bit when I saw the people in the background with the virtual reality and I was like, ‘oh, I’ve been in this environment before, I know how to operate it,’” Bischoff says. “So I thought that was interesting. I wasn’t expecting that. Just exposure to what that atmosphere is, as far as the lighting and the tent set up. It’s not a clean, sterile environment that you would experience in a clinic or a hospital. It feels grittier.” 

Fellow student Air Force Capt. Daniel Vortolomei says while he hasn’t been deployed in a combat situation, the atmosphere felt realistic but he didn’t find it too distracting.

“You’ve got to really zone in on your thinking and not necessarily get distracted by stuff going on behind you,” Vortolomei says. “You’ve got one mission, and that’s to take care of the patient.”

While both students were focused on the needs of their simulated patients, they also said they were impressed with what the facility could offer.

“This is what makes USU unique,” says Vortolomei. “It gives us the opportunity no one else could provide.”