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Mixed reality offers an innovative approach to training complex medical skills in mass casualty incident simulations. This pre-post test study aimed to describe mixed reality feature priorities for mass casualty incident simulation from the end-users’ perspective and to explore the extent to which priorities changed following implementation. A mixed reality training program was developed to improve medical first responders’ triage skills in mass casualty incidents. Five European emergency medical service end-user organizations were asked to prioritize mixed reality training features in five content areas: the live training system, equipment, debriefing dashboard, analytics and statistics, and the manikin. The baseline (T1) survey was completed in late-2022. Six field trials were carried out between June 2023 and January 2024. The follow-up (T2) survey and group discussions were completed in early-2024. Follow-up responses tended to be more polarizing, with fewer features rated as must have (T1, 54.1%; T2, 46.4%), and more features rated as should have (T1, 19.6%; T2, 23.9%), could have (T1, 17.6%; T2, 18.4%), and won’t have (T1, 6.4%; T2, 10.7%). Prior to implementation, end-user organizations prioritized mixed reality simulation features that promoted realism. Following implementation end-users were more pragmatic, assigning higher ratings to features that aligned with the required learning goals and objectives for mixed reality mass casualty incident triage training. Changes in end-users’ priorities demonstrate a need to evaluate mixed reality simulation feature priorities before, during, and after implementation to ensure relevant feature selection and technology development.

Well-prepared medical first responders (MFRs) are indispensable for effectively managing mass casualty incidents (MCIs). Still, the gold standard for training, high-fidelity real-life exercises (RLEs), is infrequently implemented due to high organizational effort and costs. Mixed reality (MR), where MFRs train in a virtual environment with haptic feedback from manikins, may be a viable training alternative. This study aimed to explore strengths, limitations, and potentials for improvement of MR-MCI training in relation to two RLEs. Thirty-four MFRs (Mage = 29.7, SDage = 7.7, 82% male) participated in MR training, 14 MFRs in RLEs (RLE1, akin to MR: n = 4, Mage = 32.0, SDage = 9.5; RLE2, near-ideal: n = 14, Mage = 26.9, SDage = 6.7; 100% male). Stress, exhaustion, self-efficacy, presence, and perceived learning gain were assessed using questionnaires and analyzed descriptively. Participants further answered open-ended questions about perceived opportunities and limitations of virtual training. The MR and RLE groups reported similar stress, exhaustion, and self-efficacy levels. The MR group reported slightly lower physical presence but considerably lower social presence than the RLE groups. Perceived learning gains were moderate for MR participants and high for RLE participants. Qualitative data indicated a need to improve interaction opportunities with virtual patients. Also, participants viewed virtual training as a resource-efficient supplement, not a replacement for RLEs. Future studies should explore which content and groups benefit most from MR and further evaluate it through larger, experimental studies. MR-MCI training shows promise in preparing MFRs for MCIs and seems to be a valuable addition to RLEs, with the potential to increase training frequency and practice scenarios otherwise difficult to simulate.

This study examines a Mixed Reality (MR) simulation aiming to train first responders for mass casualty incidents (MCIs). The focus is on how trainees and instructors use workarounds to address uncertainties, and technical glitches during the simulation. Advancements in MR offer new approaches to MCI training, either replacing or complementing traditional methods. Using observations, audio and video recordings, and interviews, we analysed interactions through Goffman's concepts of ‘frame,’ ‘footing,’ and ‘rules of irrelevance. Findings show that participants in this MR simulation use a range of workarounds, to deal with glitches that arise in the training system and uphold the simulation, bridging gaps between real-world tasks and the MR simulation. Workarounds can be understood through the participants' framings of the situation, and how they shifted footings and frames. Findings demonstrated the importance of considering which representation from real-world work practices needs to be included in the simulation to ensure workarounds do not hinder the intended learning objectives. To mitigate this risk, organisers, instructors, and trainees must develop and deepen their competencies and understanding of the pedagogical underpinnings of simulation practice. These insights underscore the importance of viewing MR simulations as distinct practices with their own logic and conditions.

Objective: Despite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct a comprehensive examination of traditional MCI scenario training methods, focusing on their inherent strengths and limitations. An investigation into the perceptions of MFRs who had participated in MCI scenario training was carried out to identify potential areas for improvement and provide recommendations for refining MCI training protocols.

Design: Qualitative inductive approach using semistructured interviews that took place between October 2021 and February 2022. Data were analysed with qualitative content analysis.

Setting: MCI scenario training involving four organisations (three emergency medical services and one search-and-rescue organisation) tasked with responding to MCIs, collectively representing four European Union countries.

Participants: 27 MFRs (17 emergency medical services personnel and 10 search-and-rescue volunteers) were recruited to participate in the study.

Results: Two categories and seven associated subcategories (shown in parentheses) were identified as influencing the learning outcomes for MFRs: Training in a context mirroring real-world incidents (conducting incident scene risk assessment, realistic representation in casualties, incorporating scenario variety into the curriculum, interagency collaboration, role alignment when training incident site management) and use of a pedagogical framework (allowing for mistakes, the importance of post-training evaluation).

Conclusions: This study reaffirms the value of traditional MCI scenario training and identifies areas for enhancement, advocating for realistic scenarios, interagency collaboration, improved incident site management skills and thorough post-training evaluation. It suggests a shift in MCI training conceptualisation and delivery. The potential of virtual reality technologies as a valuable addition to training methods is explored, with a note on the need for further research to ascertain the long-term effectiveness of these technologies. However, the selection of a training method should consider programme goals, target population and resources.

Context: This study is about the teaching method of simulation exercises and is set in a police education context. Simulation exercises are a central part of Swedish police education, and therefore it is of interest to explore how they are used, and for what purpose, by investigating police teachers' perceptions of this teaching and learning method. Police teachers are police officers who work as teachers at a police education unit on contracts lasting a few years, but which can be extended, and they usually lack any formal pedagogical training. 

Approach: In this study, the exploration of the use of simulation exercises was conducted through an inductive approach which included semi-structured interviews with 12 police teachers. The analysis was carried out in several steps. To promote impartiality in the initial data analysis the researcher first stayed close to the data and connection with the findings of previous studies was only considered in the latter stages of this analytic process. 

Findings: The findings show that the police teachers perceive that the overall purpose of simulation exercises is for students to apply specific content taught in courses, both physical techniques and methods, and more theoretical knowledge, in the fluid context of scenarios relevant to police work. The results also show that the teachers are aware that the purpose of the exercises is stated in the planning documents, but because they inherit the designs from previous teachers, they may not be aware of the underlying details of it or what is to be achieved in the scenario. The findings also demonstrate that the teachers learn the craft of designing and performing simulation exercises and develop their roles as teachers through an informal workplace learning process that involves tacit knowledge developed through working together, and by talking to and observing each other. 

Conclusion: The paper contributes to the field of simulation exercises in vocational (higher) education in that the findings can provide educated arguments for the need for scholarly discussions on simulation exercises as a pedagogical tool that supports student learning, as well as arguments for why formal pedagogically-oriented continuing education on the design and implementation of simulation exercises where learning is in the foreground may be needed to support police teachers' professional development. 

Previous research has shown that teachers' informal learning in social networks is of great importance for their professional development. Participation in social networks is often characterised by knowledge exchange between employees with the aim of dealing with work-related challenges or improving the work practice. In this study, attention was focused on teachers at a Swedish police education unit and their participation in work-related social networks. The findings were based on two data collections, logbooks of social networking interactions and follow-up interviews with 23 teachers. The purpose was to explore who they talked to, for what purpose and what means of communication they used, and the analysis included mapping of their interactions in social networks and a qualitative analysis of their narratives. Overall, the study shows that the teachers' participation in social networks was extensive and valuable for their professional development as teachers. Furthermore, the analysis shows that the teachers' interactions in social networks are usually intentional and based on knowledge needs related to pedagogical aspects of teaching, that the composition of course content and teaching teams can affect teachers' readiness to participate in several different networks and that the type of knowledge need affects which means of communication are used.

Mixed reality (MR) technology has the potential to enhance the disaster preparedness of medical first responders in mass-casualty incidents through new training methods. In this manuscript, we present an MR training solution based on requirements collected from experienced medical first responders and technical experts, regular end-user feedback received through the iterative design process used to develop a prototype and feedback from two initial field trials. We discuss key features essential for an effective MR training system, including flexible scenario design, added realism through patient simulator manikins and objective performance assessment. Current technological challenges such as the responsiveness of avatars and the complexity of smart scenario control are also addressed, along with the future potential for integrating artificial intelligence. Furthermore, an advanced analytics and statistics tool that incorporates complex data integration, machine learning for data analysis and visualization techniques for performance evaluation is presented.

Collaboration is essential for successful emergency event management. Live exercises are one method to prepare for such emergencies. In this paper, we present and evaluate an exercise model for multi-agency collaboration between first responders that focuses on learning collaboration. The model design emphasises preparation, the learning climate, scenarios that support learning, and reflection. The model is underpinned by a practice perspective on learning and structured reflection. Data were collected from three collaboration exercises using questionnaires in conjunction with the exercise and interviews at a later time after the exercise. The analysis showed that the participants developed a knowledge of collaboration and improved their ability to collaborate in real emergency events. The main contribution of the paper is the validation of a small-scale exercise model that places learning of the subject matter in the foreground, which is shown to be a successful method for developing relevant knowledge. It is concluded that this live exercise model both complements the more commonly used large-scale collaboration exercise model and strengthens emergency preparedness.

This article examines how a virtual case that prepares students for practical scenario training affects police students' performance in a practical scenario training. This study included 69 Swedish police students at the Basic Training Programme for Police Officers – 35 assigned to a virtual police case (VCASE) and 34 assigned to a conventional teacher-led (CON) lesson. A questionnaire captured how students experience training conditions and a blind assessment by police officers evaluated the students' performance in the practical scenario training. The results show that both the VCASE and CON participants thought that the training they received before the practical training was meaningful and motivating. However, to a significantly higher degree than the CON students, the VCASE students thought that their preparation helped them during the practical training. The expert assessment of one practical scenario (stopping a suspected stolen car) showed that the VCASE participants performed better than the CON participants in three out of five criteria. In conclusion, the VCASE and the CON training had different effects on the students' performance in the practical scenario: compared to the CON training, the VCASE training seemed to more effectively help the police students solve the situations presented in the practical scenario training.

Purpose – The purpose of this study is to explore Swedish police education teachers’ informal workplace learningand its perceived value for their professional development. Two categories of teachers, police teachers and universityteachers,with different professional knowledge and experience, work together at the police education unit.

Design/methodology/approach – The method used was in-depth interviews with teachers working at aSwedish police education unit.

Findings – Informal workplace learning was perceived by both teacher groups to be of great value forgaining knowledge about the local practice and for their professional development. Their learning emerged indiscussions, observations and practically oriented activities in their daily work. Four conclusions: firstly, theteachers’ informal workplace learning was socially and practice-oriented and learning emerged in acollaborative, reciprocal and active process. Secondly, the embodied nature of the learning is evident in theteachers’ joint activities in the teaching practice. Thirdly, it takes time and active involvement in the localpractice to become a professional teacher in this kind of education. Fourthly, an educational structure whereacademic knowledge and experience can be integrated with police knowledge and experience constitutes animportant basis for teachers’ professional development in police education and training.

Originality/value – The study’s focus on police education and the professional development of teachers inthis specific practice contributes to increased knowledge of the social, practice-oriented and embodied natureof informal workplace learning.