Jon Brouchoud: Welcome to Simulation Pulse Live. It is episode 43, Friday afternoons at noon central. Today we have a very special guest and I’m going to let Rick Casteel introduce, but I also want to introduce Bill Ballo from Madison College. I’m Jon Brouchoud from Arch Virtual and developers of Acadicus. And Rick Casteel is our customer experience specialist, and he’ll be introducing our guest today.

Rick Casteel: All right. Great. Thanks, Jon. And I want to welcome our very special guests today. We have several folks here, and I always never feel competent introducing people, right? Because I’ll get a portion of their name wrong or, you know, how long did it take me to figure out not to say the D in your last name, Jon? I mean, right? So I’ll give this a shot, but I think I’ve given everybody that’s here the ability to speak and be on the panel.

So I will say that it’s very exciting to have when our customers come on and join us to show what they’ve been doing. And I’m especially excited to see what we have to see today with this group from the USAISR, which stands for US Army Institute of Surgical Research. And I’m not going to go much further with this. I’m going to let them introduce themselves and talk a little bit more about what they do.

And then we’re going to talk about what they’re doing with Acadicus. Because again, I’m really blown away with what they’ve kind of gone off and built from scratch for themselves. And I’m anxious to really get down and be able to show it. So with that, we have Sena Veazey here with us. Sena is the head of this group. And again, she’ll tell you what her title is and her role and tell us a little bit about their organization. And then she has some colleagues with her. David and Jacob and Becky and Sydney’s in there. But Sena, if I can turn it over to you, you’re going to do such a much better job than I am right now. And you can introduce everybody and talk about what it is that USAISR does.

Sena Veazey: Yes. Hello. Can everyone hear me?

Rick Casteel: Yep. Loud and clear. Perfect.

Sena Veazey: Okay, great. So my name is Sena Veazey. I am a data scientist and principal investigator here at the Institute of Surgical Research. Been here for almost nine years. I’m working in the virtual health space involving clinical decision support systems, telemedicine, medical AI. We belong under the current Organ Support and Automation Technology Research Combat Research Team Group or CRT3 under the supervision of Dr. Jose Salinas.

And we’re really excited to tell you a little bit about, you know, our initiatives here at the ISR and within our research product and what we’ve been developing here along with Acadicus. And I have several members of our team here as well, and they can quickly introduce themselves. I can’t see all the participants, so… Okay, I’ll go down the list for you, Sena, and I’ll call them out.

Rick Casteel: Oh, okay. I’ll start top to bottom. Jacob?

Jacob Rivera: Hello, everybody. I’m Jacob Rivera. Um, I’m, uh, the, uh, junior software developer that’s working on this VR project with Sena, David, Nicole, and, uh, and Sydney. Um, long story short, I’ve helped build out about three different scenes or so up in Acadicus, just trying to help teach people some basic burn care. And, uh, we’re going to be walking through some of it today.

Rick Casteel: Okay.

Jon Brouchoud: David, I think we might need to make David and Sydney.

Rick Casteel: Got it.

Jon Brouchoud: Sorry.

Rick Casteel: That was my fault, David.

David Luellen: OK, can you hear me?

Rick Casteel: Yes, we’ve got you now.

David Luellen: OK, great. I’m David Luellen, working at the ISR going on 13 years. I’ve been working for Dr. Salinas all that time, so that’s good. I’m the primary HoloLens developer, so I’m more in the AR spectrum versus VR. So Jake has all the VR experience right now, and I have the AR side. But we can teach each other both, so that’s good.

Rick Casteel: Thanks, David. Sydney?

Sydney: Oh, yes. I’m also here with Nicole. So she’s going to go after mine. OK. So yeah, I’m new to the ISR, and I’m a data analyst. And so I am just kind of helping with the projects that they’re doing and loving it so far. And I’ll let Nicole go next as well.

Nicole Caldwell: Hi, Nicole Caldwell. I’m a research nurse coordinator. I’ve been with the ISR for about 12 years. And I’m the one that does all the human subject research testing. So I help coordinate the studies and collect data on how the technologies perform.

Rick Casteel: Okay, great. And we also have Becky and Mitch with us out there. I’ve given everybody permissions to speak. So if you have something you want to say or ask a question, just go ahead and feel free to either send it in the chat or raise your hand and then we’ll have you speak out. So Sena, do you want to take it from here? And I didn’t know if you had a maybe a presentation you wanted to do first.

Sena Veazey: And then I have a PowerPoint that I can present. I don’t see a sharing option. So But I do have a small slide deck.

Rick Casteel: Okay, try. How about now?

Sena Veazey: Okay, yes, I can do it now, I think. Just give me one second. Oh, sorry. Let’s see. I accept it as a panelist. Does it give me an option for sharing? Oh, yeah, right here. Got it.

Rick Casteel: Hey, here it is. We got it. Perfect.

Sena Veazey: OK, so this should be the full screen view.

Rick Casteel: We got it.

Sena Veazey: All right. So thank you so much, everyone, for listening in about our initial initiative for using virtual reality for burn care and just going to talk a little bit about our background and research and development that we’ve done so far. And I’ve listed down our additional team members, some of the clinical SMEs that we have that are not able to attend today, but just wanted to give a quick shout out, especially to Maria Cyril Melvin. We have Major Angela Samisorin. We had Mika Gleason also to help us. I have my standard disclaimer. All the views are not a reflection of the DoD.

Alright, so a quick background about our Institute. Our ultimate mission is optimizing combat casualty care. We’re here to deliver transformative knowledge and material solutions for the future battlefield. And also the ISR holds the only DOD burn center and every combat casualty that requires burn care comes through our burn center, which is co-located at the Brooke Army Medical Center at Joint Base San Antonio.

Just a little bit of information from our burn center. Our burn center director is Dr and then our chief medical officer is Colonel Williams. I have some older data, but back in 2021, we had approximately 561 admissions with 892 OR cases and over 2,000 outpatient visits within our burn center. Something that’s a little bit unique is that we also have our own burn flight team and we also have a burn center educational program.

So some of our missions that we completed using the burn flight team was like back in 2017, there was a training accident in California. I don’t remember if you recall back in 2018 in Guatemala, there was a volcano incident with burn children where our burn flight team went in and help support the missions over there. There’s also an ECMO program. And so they were able to do approximately 16 different ECMO transports as well.

We have part of our burn center education and training. We have a pre-deployer program as well. And so we have multiple people who rotate in and get burn specific training prior to being deployed. And then we also have a graduate medical education, the GME program within BAMC. So back in 2021, we had about 148 residents that would rotate within the burn center as well.

We’re also joint with the Clinical Research and Education Program, so we also conduct various clinical research studies from various sponsorships from the DoD, BARDA programs, or industry sponsors. And then our educational team, we work very closely, especially with this particular VR project.

So I wanted to talk a little bit about the unique aspects in terms of why are we trying to address burn care and education differently compared to civilian and the military aspect. And so what we have here is this emerging operational environment, which is this multi-domain battle, or now we’re calling it the large-scale combat operation or LSCO. And the terminology changes every few years, but the general idea is that we’ll have near-peer adversaries that may inhibit communication abilities for all personnel, including medical.

And having access to any type of remote experts for medical care via telemedicine may be intermittent at best, they may be blocked with newer technologies. And we’re already seeing that with the fight in Ukraine. There’s going to be limitation of resources and a delay in evacuation. We’re calling that prolonged casualty care where we’re having to hold casualties much longer.

If you recall in the past, warfare with Iraq and Afghanistan, we were able to have the golden hour where we’re able to evacuate casualties within one hour from point of care to some sort of field hospital. And however, we’re expecting that it’s going to be beyond one hour and maybe up to 24 hours or more, even up to several days where you will not be able to go into some definitive care with definitive surgical capabilities.

And so imagine, you know, a person in the civilian side being shot by a gunshot wound and an ambulance is not able to pick you up typically within five to 15 minutes. Imagine if someone with some initial medical capabilities is taking care of you now for 24 hours before someone could send you to the hospital. That’s kind of the aspect that we’re faced with at this time.

So another limitation in this whole environment is that clinicians that are far out in the battlefield will not have advanced capabilities or skill sets potentially. And so they may be performing beyond their initial training and skill sets in order to maintain a patient. And so there may be other advanced technologies that may provide some of the solutions to address some of these requirements in this environment.

So the reality of burns is that we’re expecting that there may be a growing threat of explosions that might also cause a burn mass casualty incidents, BMCIs, and that has been a requirement for us to conduct research on how can we mitigate these large burn casualties. The large scale disasters could potentially turn an entire community into an austere environment and any other regional burn centers that may be around in that area will be limited with the amount of care that they’ll be able to provide.

And during some experimentations, when they’re looking at potential events, they’re expecting that you’re gonna have tens to potentially up to thousands, depending on the weaponry that is being used. So burn care can become a critical healthcare bottleneck because burns is a type of trauma, but it’s a special type of trauma that often requires different skill sets and needs.

So there’s gonna be a lack of burn beds initially, and then you’re going to have a lack of adequately trained personnel. And even if you pull in other medical providers, they might not have the appropriate training or how can you train them just in time for these mass casualty events. And there’s a lack of a force multiplier. How do we get more people involved in doing burn care? I’ll stop right here. I know that was a little bit dire and like post-apocalyptic, but these are things that were challenges that we’re facing right now. But if anyone has questions so far about this.

Rick Casteel: This is interesting. And you’re right, it is heavy stuff, but you have to plan and prepare for the stuff we hope never happens.

Sena Veazey: Exactly. We hope that this never happens, but we are trying to prepare as best as possible in order to address this in case there ever becomes an incident. Okay, so how can we address this? Our group is tasked with looking at new technologies, and so we’re looking at a lot of extended reality technologies and how it can be applied to medical care.

Right now, our two arms is mainly involving mixed reality, and then we have that new arm with virtual reality. With the mixed reality, we are looking at real-time decision support systems. So can you wear a headset, deploy a medical app, and then it just guides you in real time in order to conduct surgical procedures or patient management while you’re actually taking care of a patient. We think that that technology is best suited for that kind of work.

And then virtual reality we think would be best intended for this immersive interaction, mainly for training. And we’re looking at how do we train in masses in case that we have a lot of soldiers to train on because we only have a very small limited number of burn educators here at the ISR and all of the burn training collectively is done mostly at ISR with some aspects being taught at other medical training events, but most of the actual care being able to see patients, touch patients, getting the learning aspect that happens at ISR. And, you know, we only have so many people and so much time.

So the use cases for virtual reality for training. So a little bit differently of how we can, you know, really utilize this is we can potentially simulate patients that are specifically for combat casualty care. which would then eliminate needs for actual physical mannequins whenever you’re doing your training. Also, you can have realistic instruments that mimics the resource limitations so we can develop scenarios where you’re faced with only the equipment and supplies that would typically be in an outside facility like a battalion aid station, where as opposed to in a hospital setting where you have a lot more equipment and instruments that’s appropriate for that environment, but we can then replicate a different one in VR.

So we find that this can be a really great way to not only show the trainees, like what they would be faced with but having that realism as well. So some things that we take in consideration for our actual research is like we evaluate and determine the effectiveness of that technology that’s best suited for our unique military needs and making sure that they’re safe, they’re effective, and they’re usable. And we’re investigating these novel solutions for that LISCO environment.

And, you know, we talk about this prolonged casualty care, and we know that there are a lot of other investigators, like, such as NASA, that’s looking at extended reality technologies as well. And then there’s been a lot of literature already that’s backing up that VR is a really good way, not as a complete substitute, but as an add-on so that you can have different ways to teach. And they’ve shown that VR can enhance memory retention. It makes it more fun. You’re immersed and it’s realistic to what you may be in. those metrics and data that’s been collecting supports the use of VR technology for education.

And again, you can use different types of equipment along with VR. There’s, you know, regular standalone VR technology where you’re just using the headset with the laptop and you’re interacting that way. And now there’s like new technologies that are hybrid where you’re in VR but you’re using a physical instrument and so there’s ways to show landmarks within your headset but you’re actually touching and feeling a physical thing and so that you get like that more realistic psychomotor skills that may be required.

Other things that we take into consideration is connectivity. Connectivity would not be an issue if you’re in a regular educational classroom or training room, but it we it may be more difficult if you’re out somewhere that’s a little bit more remote and then you know trying to get the appropriate test test subject population for our research because we want to make sure that this is evaluated by people who are going to end up using that may are more realistic of the actual end users.

And then not necessarily for VR training, but more for our other research using mixed reality is having this thoughtful design and making sure that we establish processes, especially for our future FDA clearance for software as a medical device. Okay, so Generally, for our research, whether we’re doing mixed reality or virtual reality is we have like two arms of our work, which is the usability aspect and then the performance aspect.

Usability is, you know, how satisfied are they are? Did they use it as intended? And you could do quantitative and qualitative research on the user feedback. And then that also allows our team to do any bugs or fixes, then moving on into performance. So for performance, once we have something set up and defined, then How is it effective? Does this actually affect their training? Does this actually affect their ability to be more accurate in conducting a surgical procedure? Is there a real difference? Does it make a change in actual patient care? And those are the other part of the research that we’re investigating.

These are just examples of some of the validated surveys that we’ve used previously, especially for usability, and we’re going to incorporate some of this in our research for our VR. And so now I’m going to go into our actual VR development. I’m going to talk really briefly about this. I think it’s better to show what we’ve developed, and Jake can do that, and I can walk you through that.

But very briefly, part of our VR development if we’re going to transition this into an actual burn education part that’s part of the ISR education program is to make sure that they’re aligning that we’re aligning all the learning objectives. So we align them with the Advanced Burn Life Support Program. So the ABLS program is sponsored by the American Burn Association. They’re the ones who certify all the burn centers. And then you can also get a certification for the ABLS certificate when you attend their specific classes.

So we’ve integrated some of their learning objectives into our VR scenario. And then we also put in additional military knowledge and considerations that are specific for our military needs. And then we also looked at the nurse competency checklist, like what are other groups learning about specifically for burns to make sure that we’re addressing all the core competencies for burn care. And we established three different scenarios at this time. So we have three scenes. The first scene is an introduction to burns and skin pathophysiology. The second one is how to calculate total body surface area burn. And then the third scene is we have a burn triage scenario.

So for our development and some of our limitations, right now we’re trying to finish up our last burn triage scenario. The other two things have been clinically validated with our SMEs and the burn education team. And then right now we’re also working on our IRB human subject research protocol so that we can get initial feedback from clinicians so they can provide additional inputs about the different topics that we’re addressing. We started off small.

And then what else can we expand on like what are the top needs like burn fluid resuscitation or an escharotomy looking at general usability and we have a very limited pre and post questionnaire just to gauge in general like what knowledge do they know, go through the VR sim, and then see what knowledge did they gain. And we’re planning to conduct this study in a few months in September.

So VR is still a new area of research and development for ISR and for the DoD combat casualty care. Just a little bit of background information. We do a lot of research, but not necessarily on training. We’re really held by the type of funding mechanisms that are brought, Within the army funding dollars and so training, unfortunately, is not, it is a priority, but not necessarily for training, education, research, there are other mechanisms before, like, the funding that we did receive is pretty limited.

And so being able to explain VR and what it does and what we’re trying to do with the technology has been quite a challenge within our institute. So, we had to do some ad hoc changes to our initial design with Acadicus and the Acadicus team. So, we weren’t able to purchase some customizations, but I do have to say that the Acadicus platform with their free libraries of the tools that’s already out there, we were still able to make changes enough where we can still do something with our research dollars and and we’re really pleased with like a lot of the help that we received from the Acadicus team.

So some things that we wanted to do but would be nice to do in the future would be integrating more burn-specific characters and customizations of burn-specific interactions. So being able to turn, flip patients so you can do better assessments, having more realistic burn skin, especially if you’re cutting into a skin, burn skin just reacts differently when you cut compared to normal skin. And then adding new instruments and environments. So having a more realistic outdoor military tent environment that is replicative of like a role one or two facility or a battalion aid station.

And just overall in any type of training, education, research, longevity studies on how people are learning is very difficult and it’s been, and it will become, it is, difficult now and in the future just because we have a lot of rotating personnel. So even if we try to get feedback and initial research with like the burn flight teams or the rotating members that go through the program, we may not see them again. So doing like any type of longevity studies is kind of difficult. Any questions so far?

Rick Casteel: Do we want to pause here for a moment? Does anybody on the panel or anybody that’s joining us today have a question for Sena? I mean, this is just all really fascinating to me. I mean, this is so in-depth and thorough, I must say, probably more so than we’re used to seeing, but I love the thought that’s gone into making this the best program it can be for you.

Sena Veazey: Yes, we do and some of our future initiatives is like to obtain some extramural funding to continue with the medical simulation and training to empower our warfighters and hopefully we can secure more funding so then we can continue to expand on what we’ve already developed and we’ve already showcase some of our work with the burn center director. We work closely with the chief medical officer here at ISR. Maria’s already within the burn education team and so we have like all the right people engaged. We just really need to kind of push through and and kind of finish this out so then we can try to translate this into an actual product.

Rick Casteel: Well, and I relate to what you said earlier, too. Trying to convey to somebody or help them understand the impact you can have through a VR training session is difficult with somebody who’s never put a VR headset on. Exactly. Yeah. So I can relate. Any questions from the group?

Jon Brouchoud: No. Great, great presentation. Fantastic.

Sena Veazey: All right, thank you. And then I’m done on my end, and Jake is ready. He can show screen share his.

Rick Casteel: Yep, he should be able to take it over. Is that right, Jake? You good?

Jacob Rivera: Yep, give me a second. My headset just overheated, so I’m just restarting everything really quick. But I should be done within the next minute.

Rick Casteel: OK, no problem. And I’m really anxious to show this all. I got to go in a couple months back, and I got to say, Jake, the work that you’re doing.

Jacob Rivera: All right, we’re loading into it now. Let me go ahead and start screen sharing.

Rick Casteel: Go ahead.

Jacob Rivera: Okay, is everybody seeing everything.

Rick Casteel: Yep, we have your screen. All right. Right.

Jacob Rivera: Cool. Um, sorry. All right. Did you share with video.

Jon Brouchoud: Uh, it seems like the, when you share your screen, there’s an option to share for video optimized for video. So that we’ll get a smoother frame rate. Maybe optimize for this video. Okay. Yeah. Just try to stop sharing and reshare. And then there should be a little checkbox optimized for video or something like that. That’ll give us a little better frame.

Jacob Rivera: So stop share and then share screen. Ah, there it is optimized for video clip. Awesome. Awesome. Perfect. Thank you very much. Perfect. How’s that looking?

Jon Brouchoud: Perfect.

Jacob Rivera: Great. All right. Well, without any further ado, hello, everybody. I’m Jacob Rivera. I’m the junior research developer who’s helped work on some of the virtual reality stuff that we’ve got going on here. As Sena said, we have three different scenes to show you guys today. The first one covering burn pathophysiology, the next one covering triage, the next one covering TPSA, rather, total body surface area, and then the one after that covering triage.

So this is our first scene. It’s a class, it’s just a regular old classroom environment. Rick, that’s actually the same skin model that you imported previously during this classroom, but everything else we did from the ground up here. But the way that people will usually learn as they walk through here is that they’re going to be interacting with these little boards that we set up. So we have some information here, you would read through it. And then you go ahead and tab through everything. Well, let me go ahead and double check if I know everything question, yada, yada, yada. Let’s say, oh, hey, I was correct.

Sena Veazey: And I also what we’ve done here is we have more of a mixed didactic slash VR kind of scenario, so we have the content for the learning materials. And then we have quick checkpoints here because we want to have some sort of more interactive element while they’re walking through this virtual classroom.

And what we’ve done up front in the very front of the classroom is we’ve defined the different learning objectives. So we introduce them to the classroom. We have the learning objective here on the whiteboard. And so then they know what they’re going to learn. And then we also have incorporated other aspects such as we really utilize a lot of the ghost recordings as well, just so that you can also see someone talking you through and providing a little bit more information.

From our other usability studies, we found that a lot of people don’t like reading a lot of text. So the thing that we really focused on for this virtual slide deck is truncating and putting the most salient information for each topic. And then we, AdLib, we have a script actually written and we have the ghost recording to give you like the additional information so that you’re not forced to like read a bunch, like several paragraphs worth of information.

Rick Casteel: I just want to call out here, Jake, all of this content, you know, obviously you’re in the Acadicus environment and you’re using the platform. But all of the content, the text, the graphics, the images we’re seeing are all things you brought into the scene, correct?

Jacob Rivera: Yes, sir.

Sena Veazey: Yes. So we’ve used the different tools in the library, and we got really creative. And Jake was also really great at how do we use different things for bringing in within our environment. And so, for example, we use a lot of the panel capability in here so that we can post images. We have the ghost recording Jake made. He made like this knowledge checkpoint thing. It’s like a picture, but then we use interactive buttons and so they’re all kind of laid out so it looks like a functional form, but it’s actually multiple different things that we put in there just so that it looks like it, but it wasn’t actually intended to function like that exactly before. That makes sense. So we were pretty creative in how we added all these.

Rick Casteel: And I’ve got to give Jake a lot of credit here. He has started this whole tsunami of consideration about how we use these just correct and incorrect assets, right? Those answer assets now within the platform. And a lot of our users, Mitch is one, he’s on the line here and Bill and Dr. Slayman, when they saw this, right, we had a bit of a moment going, oh my gosh, you know, we never considered using it this way. So Jake, goes to you, my friend, you have really kind of outdone even us at this point. This is great.

Sena Veazey: Thumbs up. Yeah, when you’re forced to be really creative, I think we did some really interesting things with the tools that were available to us. Yeah. So at the end, once you read through most of the slide decks, then we have the large pictures. It’s kind of like a mini quiz on these dry erase boards. And our intent was trying to make the room familiar with how people generally interact with a classroom or like in a conference setting where you know you have different posters and so you posters on easels and so we took a picture of a of an easel and then overlaid that with another picture and to make this thing. And so we have the descriptions, we read you, so these are real patient photos that we have that’s integrated in here. We describe the photo and then you’re, based off what you know, you should be able to answer the questions on what kind of burn is it. Is it a superficial, partial, or full thickness burn?

Rick Casteel: And again, even when you’re asking Yeah, during our recording here, and we’re all sitting here looking at it on a flat screen, but Jake‘s obviously in the headset. And Jake, can you talk for a moment about how different it is in experience being in the room there doing it versus kind of what we’re watching you do?

Jacob Rivera: Oh, yeah, no, absolutely. It’s night and day to say the least. Just using everything inside of, say, desktop mode, I guess that’d be the closest analog to just having everything recorded. Um, like, yeah, sure, you can walk around and everything and interact with all the objects. I personally made sure that everything’s still interactable and desktop mode, at least for the most part. Some of the stuff does require you to get hands on. Um, but just being actually able to, like, be in here and actually interact. With some of these models. and just sort of just explore the space. It gives you a completely different sort of head space as to like, okay, I’m actually in a classroom. I’m actually absorbing this information. It’s completely immersive. Whereas if you’re just sitting in front of a desktop, you’re just, oh man, this is like, okay, cool. It’s an educational game, but it’s not immersive. You know, like you look around, you’re still inside your office.

Rick Casteel: Right, right. You have to play your recording in the skin diorama.

Sena Veazey: Yeah, the skin diorama is pretty funny. So we worked on the skin diorama, like we worked with what we had, and then what we did was we found a picture and then scaled it to represent the layers of the skin.

Jacob Rivera: This right here is our skin diorama. Here you can see the epidermis, dermis, and subcutaneous tissue. We classify different depths of burns by determining if they go into these different tissue layers. Take a look at this infographic for more information.

Rick Casteel: See, that’s just great. I mean, that’s just like low rent special effects, right? I mean, it’s awesome.

Jon Brouchoud: That’s so cool. I love how you sink back down into it when you’re done, like a little puppet show.

Sena Veazey: Yeah, that was all Jake‘s idea. That was awesome. That’s super cool.

Rick Casteel: That’s the kind of thing that engages your users, you know? They get really into that.

Jacob Rivera: All right, hey, should we move on to the next room or?

Sena Veazey: Yeah, let’s move on.

Jon Brouchoud: And I know it’s really hard to do, but if you could keep your head a little bit more still, like it would just, it’s just a little bit. Oh, God, yeah, I’m sorry, I’m excited. No worries at all. I’m taking a look at everything. I do the same thing, I do the same thing all the time. It’s very difficult to do when you’re in VR, because you want to look around and see everything.

Jacob Rivera: And… There we go, right. So this is our total body surface area scene. Like previously, there’s a number of boards for you to click through, just covering basis of TBSA, burn severity, terminating severity, rule of nines, very important that you learn that one. And then also Palmer method as well. And we go through all of this with the understanding that, hey, what if we actually ask PG to try and apply it?

So this is actually one of the patients that that that Acadicus does have built into it just right off of the bat. And we noticed that, hey, you know, this patient does seem to be pretty incredibly burnt. Let’s see if we can actually have people conduct total body surface area assessment of this patient. Right. So what we’ve done is that we’ve imported a little rule of nine chart here that you can fill in. We can go, oh, you know, the legs burn, you know, arm burns a little bit. Yeah. This guy, this guy, maybe a little bit of chest. Yeah, sure.

And you can compare that against, say, an answer that we’ve already had made and go like, well, yeah, so it was actually both the lower legs and then left and then right leg extends all the way up. And it’s actually, you know, like full length of the left arm, half the length of the right arm. There’s a little patch on the belly there. And then you can also ask the question of, oh, hey, how much of this TBSA is, how much is this in percentage, right? So you could go, I don’t know, looking at these different areas that were on the correct answer. and go like, oh hey, you know, that’s a full leg, that’s da da da da da. I’m just gonna go ahead and estimate maybe, let’s say 26 to 35 percent. Ah, wrong. How about this one? Ah, 36 to 45 percent-ish. All right, cool.

And then we also matched this patient to some anonymized burn patient photos that we have as well, just to give people an understanding of, oh, hey, what might this look like on a real patient that had experienced similar injuries to what this Acadicus patient has experienced. And we also cover, I believe, burn and blast injury right there as well. And also a little bit of environmental storytelling, as some of the people in game dev might call it. It’s like, oh, hey, you have a burn patient. Oh, hey, you have a car crash. Two plus two equals four, right?

Nicole Caldwell: Oh, yeah. That’s great. Yeah.

Jacob Rivera: And then moving on to the final scene.

Rick Casteel: In this third scene, you’re still working on, correct?

Jacob Rivera: Yes, this third scene we are still working on this. So, triage is a really involved process and we’re trying to figure out, okay, exactly how can we best represent triage in Acadicus? Would we have, say, TCCC cars that people look up and would we have different patients? There’s also the built-in triage tool that Acadicus has. It’s just that specializing that for burn is going to be a little bit tricky.

So right now it’s just didactic content so far it’s still under construction but we have everything set up in a number of bays and you’d imagine that we would have different patients for each bay that you would be able to go over estimate TBSA estimate how much flu that would be need to be administered and also just what triage category that patient would fall into so yeah All right, so that’s pretty much the long and short of it. If anybody has any questions so far right now, it would be appreciated if you ask them. Go ahead and fire away.

Rick Casteel: OK, group.

Jon Brouchoud: Well, this is fantastic. I would say inspiring. This is super cool. I really like how you’ve implemented this. And like Rick said, I think you gave us all a lot of ideas for ways that we could you know, kind of, you know, customize the use of these traditional assets and use them in really interesting ways that, interesting and unexpected ways, I would say.

Rick Casteel: Thanks, guys. Here’s from Mitch. In the second scenario, how did you make the learning platform?

Jacob Rivera: A learning platform in the second scenario. Are you talking about the platform that the patient was laying on?

Rick Casteel: I believe that’s what it was, yes.

Jacob Rivera: So that platform is really just a bunch of default cubes that were scaled and arranged in order to just help build stuff out. You can do a lot of stuff with primitive objects, uh, cones, tubes, spheres, stuff like that. Just a matter of just scaling them and building out how you see fit. So all of these are just default cubes that have been scaled and, uh, shaped and moved appropriately.

Rick Casteel: Yeah, we have a category called shapes and you, I guess you were just pulling them out and scaling them, right? Yes, sir.

Sena Veazey: Yeah, all of the assets that we’ve used as part of the Acadicus library, and so we were just pretty creative in how we were able to develop like this little little platform. And the idea that we have is, you know, we wanted people to be engaged, like walk through this scene, look at the different slide decks that we have on there.

And then once you’re done reading and learning through here, then you’re presented with an actual patient. And we just framed it in this way of like this little platform. and we had a PrEP4 research protocol approved in order to obtain de-identified patient photos and we scoured. And by we, it was Dr. Williams, who was our OR burn surgeon as well, was able to scour through all of her patients to find photos that would be representative of the virtual patient that we have here so that you can see in parallel the virtual patient burn and then what that would actually look like on a real person.

And so it took some time to kind of match a real person to this virtual person, but we did the best as we could since we couldn’t do our actual customizations.

Mitch: Before developing something like this, what type of VR knowledge did you have prior to putting this together on the Acadicus platform?

Sena Veazey: So from our team’s perspective, we’re pretty novice. and developing VR in general. We didn’t want to necessarily have a whole scenario developed by a company um, development team where we just give them requirements and they make it and then they just give it back to us. We want to have a more involved process where we’re able to use like some sort of toolbox. Um, we are, um, in general, like Jake and I and other people on our team are like VR enthusiasts, like hobby game players. Um, but we, this is our first VR project.

Mitch: Yeah, the reason I ask that is because I think this is an excellent example of, you know, people kind of coming in with maybe some base knowledge, you know, um, but in general, just being able to find certain things within the app, go, Hey, this is what I want to pull out or within the program. This is what I want to pull out. This is how I want to put it in there. And then kind of, you know, just building it and using your creativity. I love what you did. in comparing the pictures to the burn patient. It’s a really great example of how you can use some of the assets like the visual boards and things like that to pull in there. I really like that. So yeah.

Sena Veazey: Thank you. And we really appreciate that feedback. We wanted to have that flexibility to kind of build what we wanted to build without necessarily going constantly back and forth with the design team. We did a market analysis of and talked to multiple VR companies because there’s a lot of VR companies that are now coming into the DoD space to address some of our unique needs. But we stuck with Acadicus specifically because you have like these tool sets that you can kind of build out the things that you want because sometimes things change and especially we’re not driven by a contract requirement because we’re a research. So part of our research we’re going to be changing things and it’s hard to constantly change things as part of the research changes as well. Over.

Mitch: Yeah, I can also imagine that would really slow down what you’re trying to do if you had to constantly be bringing things back to a company and saying, OK, we need to change this. We need to change that. I mean, you know, in the world of VR, if you’re if you’re if you’re moving quickly, that that’s where, you know, like the quicker you can move in the world of VR, the better off you’re going to be. So, yeah, I’m sure.

Rick Casteel: Yeah. Yeah. To be able to sit in a meeting and say, hey, you know what we ought to do? and then go throw your headset on, right? And it’s done. And you’ve got it. I’m wondering, close to Bill‘s question, how much planning did you do in advance? Like, did you write out, okay, in this scene, this is, you know, kind of how we’re gonna flow and what we’re gonna put up in advance. And how much was it kind of ad hoc as you’re in there going, you know, what would work here is this.

Sena Veazey: Yeah, so that’s a great question. We had a general idea of what we wanted to do just because we had to provide that for our funding. And then we kind of had to scrap a lot of the things that we originally wanted to do because of the limitations of being able to purchase some of the digital assets and customizations. And so then we kind of reworked everything and said, OK, what can we do pretty quickly using the assets that we have available? And then we define like these are our top three priorities.

And then when we had a much better understanding of what assets that are now available to us, this is the concept that we came up with. And then for the actual design, Jake and I worked a lot on the initial design and then made tweaks and changes. We had an iterative design flow where we would set something up just so that other people can see it. Our clinical SMEs would validate our content. These are actual PowerPoint slides, so we have a PowerPoint slide deck. We vetted it, and then we would put it into our VR scenario, and then the clinicians would come in and walk through and be like, oh, that makes sense. Oh, this doesn’t make sense. It would be cool if you had the pictures this way. And so then we had this iterative design in how we did it.

Rick Casteel: Have you had anybody outside the VR team yet, you know, a real VR newbie actually go into the content yet?

Sena Veazey: Yes, so our burn educator education team hasn’t really used VR. They helped us with like the actual PowerPoint slides, but then we would have them actually go in the headset and walk through it. And then Jake, do you want to elaborate on other people who have gone through it as well?

Jacob Rivera: Oh goodness, yeah, I know just about everybody on the team’s gone through it. Some people with varying levels of VR experience and others. Oh, goodness. Our burn director also went through it as well. Oh, yeah. Ms. Cyril Melvin, she’s one of the best here at the ISR with regards to burn knowledge and stuff like that. But she hasn’t worn a headset before. So the first time we threw her a headset on, she was like, wow, this is great, guys. But she wanted to go ahead and adjust some of the content and whatnot. And we updated all the information to make sure it all fit accurately with ABA instruction, as well as just the knowledge that the AISR has. But yeah, so all of our SMEs, they also give us inspiration as to what new people using VR will be like.

Sena Veazey: And then this year, we also did a teaching lab over at the SOMA Conference. That’s the Special Operation Medical Association Conference. That’s where all the special ops medical go to. We were accepted to teach. at that conference this year back in May, and we talked about extended reality technologies for medical needs. We had one station for mixed reality and then another station for virtual reality, and so the people who attended our session, we had mixed levels of exposure to MR and VR. And so we had a lot of people go through that as well. And we received positive feedback on both technologies as being useful for training and for decision support.

Rick Casteel: That’s great. That’s terrific. What else? Other thoughts and questions?

Jon Brouchoud: Circling back a little bit on the scene editing process, it occurs to me that even if uh, you know, we eventually worked toward a point where the, the customization can be developed. I think this process was still valuable because I, even when we do get a budget to build something custom, and then our team goes about building it, we go through this iterative feedback, but we’re, we’re almost back to that. Like you’re hiring a company to build a bespoke application where it takes a while for our team to build something and then get back. And there’s this iterative process, but I think having gone through this exercise, it would, it would, I would. I’m curious if you think it would inform, you know, the eventual customization or the things you might do differently than you know you would have initially when you went into it, when we were going to build the customizations.

Sena Veazey: Yeah, I mean definitely having like, this forced us to, like, really explore all the capabilities and depth for all the different digital assets. And so this has given us a much greater, like, bigger idea of, like, what we can do compared to the beginning. And so now moving forward, we can say, hey, like, maybe we really did like this weird thing that we did, but we still require the additional customizations and iterative design, like, we still need better burn patients. And so that would be something without clothing, right? So that you’re able to do a more thorough assessment. That’s like one of the limitations that we have right here is that the burn patient that you’re exposed to right now, she has clothes on, but when you’re doing a burn assessment, they would have limited clothing on. But with still with the burn skin, without all the charring, or being able to wash the skin so that the debridement process is done, and so then you have a better look at a clean skin. Because here you have debrided, clean skin, but the virtual patient is wearing clothes, um, has dirt on her, so it’s, um, it’s more difficult, but this is just more of a visualization, um, and so we’re hoping that, um, there’s not too much of a disconnect between the virtual and the pictures that are shown.

Jon Brouchoud: Makes a lot of sense.

Rick Casteel: Okay.

Jon Brouchoud: Thank you very much for sharing with us. This is fantastic. I think very inspiring.

Rick Casteel: Outstanding. And as Jon said, just inspiring and has given us a ton of ideas. Mitch is saying, yep, awesome work.

Jacob Rivera: Thank you. I’m going to stop screen sharing now if that’s all right. OK. Yes.

Rick Casteel: Thank you. Thanks, Jake. Well. OK, well, that hour went by fast. And we can’t thank you enough, Sena and crew, for coming and sharing what you’re doing and how you’re using Acadicus. We can’t wait to see what else you have. And we’re looking forward to continuing to work with you.

Sena Veazey: Yes, thank you so much. And you guys have been super supportive throughout our entire process. And we’re really excited to show other people and run our study and see what the results are from that.

Rick Casteel: And Jake, we have to get some time together so that we can show you some of the other ideas for how we’re using some of this material.

Jacob Rivera: Absolutely.

Rick Casteel: I’d love to see it. Great. All right. Jon, if you want to close us out.

Jon Brouchoud: Sure. We’re at the top of the hour. We’ll wrap it up. And we’ll see you next Friday at noon Central for Simulation Pulse Live. Thanks for joining, everyone. Thanks, everyone. Bye.