Effectiveness of Multi-User Virtual Reality Simulations in Paramedic Education: A Randomized Controlled Trial

This project investigates the effectiveness and tolerability of multi-user virtual reality (VR) case simulations in paramedic education. Paramedic training is challenged by limited opportunities to practice rare but life-threatening emergency conditions under realistic yet safe circumstances. Immersive VR environments offer the potential to complement established simulation-based training by enabling standardized, reproducible emergency scenarios that approximate operational stressors without exposing patients or trainees to risk. The study was designed as a monocentric randomized controlled trial conducted at a German paramedic training academy. Full-time paramedic trainees were randomly assigned to either an intervention group, which completed two consecutive VR-based emergency case simulations, or a control group, which completed a single VR simulation. Both groups participated in an identical second VR case simulation, allowing assessment of training-related performance differences attributable to prior VR exposure. The VR simulations were based on a standardized, guideline-driven emergency scenario involving grade III anaphylaxis and were delivered using a multi-user VR platform that enabled team-based interaction in a shared virtual environment. Participant performance was assessed using a structured evaluation instrument comprising objective criteria across multiple domains of prehospital emergency care, including situational assessment, clinical decision-making, and guideline-based treatment. Primary outcomes focus on clinical performance during VR simulations, including total performance scores as well as time to correct working diagnosis and time to intramuscular epinephrine administration, which represent time-critical and clinically meaningful indicators in emergency care. Secondary outcomes include theoretical knowledge acquisition, subjective user experience, and the occurrence of virtual reality–induced symptoms and effects (VRISE). The study aims to determine whether additional exposure to VR case simulations leads to measurable improvements in performance during a subsequent virtual emergency scenario and to assess the safety and acceptability of immersive VR training in paramedic education. Findings are expected to inform the integration of VR-based case simulations into emergency medical services training curricula and to contribute to the limited empirical evidence on the educational effectiveness of immersive VR in prehospital care.