Observing the stages of bystander intervention in virtual reality simulation

doi:10.5847/wjem.j.1920-8642.2019.03.003

Abstract

Abstract:

BACKGROUND: Understanding bystander reactions to an emergency is an important component of effective training. Four stages of bystander intervention (BI) have been previously described: noticing the situation as a problem, interpreting when it is appropriate to intervene, recognizing personal responsibility to intervene, and knowing how to intervene. Using virtual reality (VR) to simulate emergencies such as sudden cardiac arrest (SCA) can be used to study these stages.
METHODS: In a secondary analysis of an observational cohort study, we analyzed bystander self-efficacy for stages of BI before and after simulated SCA. Each subject participated in a single-player, immersive, VR SCA scenario. Subjects interacted with simulated bystanders through voice commands (“call 911”, “get an AED”). Actions taken in scenario, like performing CPR, were documented. Scenario BI actions were compared based on dichotomized comfort/discomfort.
RESULTS: From June 2016 to June 2017, 119 subjects participated. Average age was 37±14 years, 44% were female and 46% reported CPR training within 2 years. During the scenario, 98% “noticed the event” and “interpreted it as a problem”, 78% “took responsibility”, and 54% “possessed the necessary skills”. Self-efficacy increased from pre- to post-scenario: noticing the event increased from 80% to 96%; interpreting as a problem increased from 86% to 97%; taking responsibility increased from 56% to 93%; possessing necessary skills increased from 47% to 63% (P<0.001).
CONCLUSION: Self-efficacy to respond to an SCA event increased pre- to post-scenario. Bystanders who reported feeling comfortable “taking responsibility to intervene” during an emergency were more likely to take action during a simulated emergency.

Key words: Virtual reality, Bystander intervention, Emergency preparedness

David G. Buckler, Alfredo Almodovar Jr, Paul Snobelen, Benjamin S. Abella, Audrey Blewer, Marion Leary. Observing the stages of bystander intervention in virtual reality simulation[J]. World Journal of Emergency Medicine, 2019, 10(3): 145-151.

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Variables	Results
Age, Mean (SD)	36 (14)
Female, n (%)	53 (45)
Race and ethnicity, n (%)
Asian	7 (6)
Black	38 (32)
Hispanic or Latino	8 (7)
Other	5 (4)
White	60 (51)
Educational attainment, n (%)
Some high school	1 (<1)
High school graduate or GED	9 (8)
Some college or vocational school	40 (34)
Bachelor’s degree	31 (26)
Master’s degree	34 (29)
Doctorate	4 (3)
Personal income, n (%)
Under $20,000	20 (18)
$20,000 - 34,999	8 (7)
$35,000 - 49,999	19 (17)
$50,000 - 74,999	17 (15)
$75,000 - 99,999	17 (15)
$100,000 - 149,999	20 (18)
$150,000 - 199,999	13 (11)
Employment status, n (%)
Employed, working 40 or more hours per week	56 (46)
Employed, working 1-39 hours per week	40 (34)
Student	17 (14)
Not employed, looking for work	2 (2)
Disabled, not able to work	2 (2)
Retired	2 (2)
Previous CPR training, n (%)
Never trained	20 (18)
Six to ten years ago	13 (11)
Three to five years ago	30 (25)
Current - less than 2 years ago	55 (46)

Variables	Pre-scenario		Post-scenario
Variables	Comfortable	Uncomfortable	Comfortable	Uncomfortable
Noticed the event	99% (92/93)	100% (23/23)	99% (113/114)	100% (5/5)
Interpreted as a problem	98% (99/101)	100% (17/17)	98% (113/115)	100% (4/4)
Took responsibility for event	85% (55/65)^*	71% (37/52)^*	81% (88/109)^#	50% (4/8)^#
Possessed the skills to deal with event	53% (29/55)	56% (35/63)	55% (41/74)^#	50% (22/44)^#