Discussion

When a nuclear and radiation emergency occurs, on-site rescue mainly includes: searching for casualties; preliminary classification (including injury detection and identification); timely rescue of life-threatening casualties; ensuring that patients with overirradiation and/or radionuclide body surface contamination, wound contamination, and internal radionuclide intake receive timely and effective disposal; collecting relevant information to analyze the medical consequences of a nuclear accident; assessing the medical consequences of a nuclear accident and medical disposal capabilities of the site; providing timely recommendations to the site emergency command; reporting to the medical emergency command to reduce the medical consequences of the nuclear accident to a minimum; establishing a temporary rescue and disposal station on site, classifying and transferring the injured; collecting the necessary samples, providing relevant information for subsequent diagnosis and treatment. ^{Reference Fu, Yuan and Liu4,Reference Qin, Li and Tan11–Reference Tsujiguchi, Kitajima and Tomisawa14} The traditional training mode of nuclear and radiation emergency first aid is mainly knowledge training and emergency drill.

However, due to the suddenness, diversity, and complexity of nuclear and radiation emergencies, there are few actual combat opportunities. Despite that most hospitals in Japan have established a radiation training system, it usually focuses on the basic skills related to patient care, especially in middle-sized hospitals, and training on response to radiological events is usually insufficient, ^{Reference Tsujiguchi, Ito and Sato15–Reference Horiuchi, Yamada and Kinoshita17} suggesting the development of new training modes is required. The implementation plan to accelerate the modernization of education (2018-2022) issued by the state council of China noted the need to promote the development of education informatization in China by constructing and developing national virtual simulation experimental teaching projects. ^{Reference Song, Jin and Tang18}

Because of its unique interactivity, immersion, and conceptual characteristics, VR technology is increasingly used in medical fields, such as surgical skills training, human anatomy simulation, and telemedicine services. ^{Reference Moro, Stromberga and Raikos19} In VR operation, the trainees interact with virtual objects and virtual characters through the controller to gain the feeling of “immersion,” which is more suitable for the teaching and training of nuclear radiation emergency medical rescue. In VR scenes, the visual scene where the radioactive dust falls to the ground during nuclear explosion and forms a radioactive contamination area can be constructed, or fluorescence can simulate the distribution of radioactive contamination in the body of the wounded under different bunkers and different protective measures, which can guide the rescue team to better master the wounded classification and retrieval method and improve their own protection awareness when performing the rescue task. ^{Reference Guo, Yang and Yu20}

The author’s unit is the formation unit of the national emergency medical rescue team and the first batch of nuclear radiation emergency medical rescue bases established by the state. In response to the attack of nuclear terrorism and occurrence of emergencies such as radiation accidents in the application of nuclear technology, the unit must undertake the tasks of emergency treatment and disposal, radiation monitoring and protection, public awareness, technical training, and applied scientific research in health emergencies. In this study, VR technology is introduced to perform training on nuclear radiation-related skills, knowledge, and emergency rescue considering the difficulties in teaching and training nuclear radiation emergencies. The results show that virtual reality technology can improve the performance, learning enthusiasm, teamwork ability, emergency treatment ability, and training satisfaction of trainees, which is consistent with the research results of other scholars. ^{Reference Vidal, Ohaeri and John21–Reference Kalisch, Aebersold and McLaughlin24}

VR technology provides various nuclear and radiation emergency training scenarios so that trainees can be completely immersed in 3-dimensional or holographic virtual scenes; experience different nuclear and radiation emergencies; feel the occurrence and distribution characteristics of nuclear radiation casualties to exercise; improve their on-site rescue and mental capacity; learn to observe, analyze, judge, make decisions, and respond in a complex nuclear radiation environment; and improve personal and teamwork and other comprehensive abilities. VR technology has the characteristics of repeatability and standardization. The various equipment of a nuclear radiation emergency platform scene is mainly obtained through computer simulation without consuming real materials, and the resources can be repeatedly used, which satisfies the requirements of repeated operation, and effectively reduces the traditional training cost. ^{Reference Wang, Peng and Dong25} In addition, the virtualization of experimental equipment and experimental phenomena avoids the safety problems caused by improper operation. In VR simulation, teachers can perform differentiated teaching, guide trainees to solve specific problems, provide effective feedback on each interaction or step of trainees, and improve the learning efficiency of trainees. The VR system has very good plasticity, although different scene modeling, wounded modeling, and scenario design, VR modality could be extended to other disaster scenarios, both in the field and in the hospital. This could certainly include explosive, chemical, and active shooter incidents.

There are several limitations in the current study. First, we only involved prehospital nuclear radiation medical rescue training of personal safety, radiation detection, triage and decontamination. However, as such training has just started in our hospital, many items, such as wound management, pollution personnel to promote discharge, and first aid for critical cases, have not been carried out in the VR system, and need to be studied and improved continuously. Second, as the volunteers involve only OR nurses in the training, population bias may exist; a radiation emergency medical rescue team including doctors, nurses, radiologic technologists, and other field staff, would be involved in the training in the future. Third, there may be bias because of the nonrandomized design nature and the small sample size of this study, for example, data collection could not be uniform and could influence the outcomes. A randomized study and an increase in the number of candidates may be further needed to confirm the benefits of the VR training method. In addition, despite that we try to ensure that the instructors are familiar with all the training content before the training and that they maintain high enthusiasm in teaching both groups, instructor-instilled bias may still exist.