Volume : 13, Issue : 09, September – 2026
Title:
VIRTUAL REALITY SIMULATION IN PREHOSPITAL CRISIS RESOURCE MANAGEMENT TRAINING A SYSTEMATIC REVIEW OF EDUCATIONAL EFFECTIVENESS AND LEARNING OUTCOMES
Authors :
Bandar Abdullah Saeed Alzhrani, Abdullah Ali Alzahrani, Ahmed Hussain Mohammed Nafea, Saad Hamed Ali Alharthi, Othman Ali Othman Alshehri, Abdullah Marshad M Alharbi, Naif Nasser Saleh Alqhtany, Abdulaziz Ahmed Mohammed Alghamdi, Khalid Mohsain Alzahrani, Abdullah Abdulrahman Alzahrani
Abstract :
Background: Prehospital emergency care requires effective crisis resource management (CRM), including leadership, communication, situational awareness, decision-making, and teamwork. Virtual reality (VR) simulation may address accessibility and reproducibility limitations of conventional simulation, yet evidence for prehospital CRM training remains fragmented.
Objective: This systematic review evaluated the educational effectiveness of VR simulation for CRM training among prehospital professionals, identified assessed learning outcomes, examined influential instructional design features, and identified evidence gaps.
Methods: Following PRISMA 2020 guidelines, a systematic search of PubMed/MEDLINE, Scopus, Embase, CINAHL, and Web of Science was conducted for studies published between 2015 and 2026. Two reviewers independently screened records, extracted data, and assessed quality using RoB 2, JBI tools, and the Newcastle–Ottawa Scale. Narrative synthesis was performed.
Results: Of 1,770 records, six comparative studies met inclusion criteria. VR improved CRM-related knowledge (p < 0.001) and performance in teamwork, communication, and situational awareness (Ottawa GRS mean 6.2/7). One randomized noninferiority trial found VR noninferior to high-fidelity simulation. Technical skill results were equivocal. Repeated, distributed exposure outperformed single sessions, whereas technological complexity showed inconsistent benefit. Satisfaction was high (95% recommended VR), though cybersickness and cognitive workload were barriers. Certainty of evidence was low to very low, with no studies assessing clinical transfer or patient outcomes.
Conclusions: VR is a promising complementary modality for prehospital CRM training, with effectiveness dependent more on instructional design than technological sophistication. Rigorous research with standardized outcomes and clinical transfer assessment is needed.
Keywords: virtual reality; crisis resource management; prehospital emergency care; simulation-based education; non-technical skills
Cite This Article:
Please cite this article in press Bandar Abdullah Saeed Alzhrani et al., Virtual Reality Simulation In Prehospital Crisis Resource Management Training A Systematic Review Of Educational Effectiveness And Learning Outcomes..,. Indo Am. J. P. Sci, 2026; 13(09).
REFERENCES:
1. Abbas, J. R., Chu, M. M. H., Jeyarajah, C., Isba, R., Payton, A., McGrath, B., Tolley, N., & Bruce, I. (2023). Virtual reality in simulation-based emergency skills training: A systematic review with a narrative synthesis. Resuscitation Plus, 16, 100484.
2. Alharbi, A., et al. (2024). Paramedic patient safety: A systematic review. [Journal details to be confirmed].
3. Asoodar, M., et al. (2024). Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education. Advances in Simulation, 9.
4. Baetzner, A. S., Hill, Y., Roszipal, B., Gerwann, S., Beutel, M., Birrenbach, T., Karlseder, M., Mohr, S., Salg, G. A., Schrom-Feiertag, H., Frenkel, M. O., & Wrzus, C. (2025). Mass casualty incident training in immersive virtual reality: Quasi-experimental evaluation of multimethod performance indicators. Journal of Medical Internet Research, 27, e63241.
5. Bell, S. (2025). Simulation in paramedic education: A systematic review. [Journal details to be confirmed].
6. Bhattarai, H. K., Bhusal, S., Barone-Adesi, F., & Hubloue, I. (2023). Prehospital emergency care in low- and middle-income countries: A systematic review. Prehospital and Disaster Medicine, 38(4), 495–512.
7. Boet, S., Bould, M. D., Fung, L., Qosa, H., Perrier, L., Tavares, W., Reeves, S., & Tricco, A. C. (2014). Transfer of learning and patient outcome in simulated crisis resource management: A systematic review. Canadian Journal of Anesthesia, 61, 571–582.
8. Carne, B., Kennedy, M., & Gray, T. (2012). Review article: Crisis resource management in emergency medicine. Emergency Medicine Australasia, 24(1), 7–13.
9. Cheng, A., Donoghue, A., Gilfoyle, E., & Eppich, W. (2012). Simulation-based crisis resource management training for pediatric critical care medicine: A review for instructors. Pediatric Critical Care Medicine, 13(2), 197–203.
10. Costa, M., et al. (2026). Different delivery modalities of virtual reality training in emergency medicine: Systematic review. JMIR XR and Spatial Computing, 3, e84310.
11. Fernandez Castelao, E., Boos, M., Ringer, C., Eich, C., & Russo, S. G. (2015). Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: A prospective, randomized, controlled study. BMC Medical Education, 15, 116.
12. Firdaus, R., Tantri, A. R., Manggala, S. K., Dwiputra, A. G., Pramodana, B., Auerkari, A. N., Hafidz, N., Omega, A., & Larasati, D. (2026). Utilization of virtual-reality in establishing a code trauma crisis resource management training module. Open Access Emergency Medicine, 18, 1–8.
13. Foronda, C. L., Gonzalez, L., Meese, M. M., Slamon, N., Baluyot, M., Lee, J., & Aebersold, M. A. (2024). A comparison of virtual reality to traditional simulation in health professions education: A systematic review. Simulation in Healthcare, 19(1S), S90–S97.
14. Fung, L., Boet, S., Bould, M. D., Qosa, H., Perrier, L., Tricco, A., Tavares, W., & Reeves, S. (2015). Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review. Journal of Interprofessional Care, 29(5), 433–444.
15. Heldring, S., Jirwe, M., Wihlborg, J., Berg, L., & Lindström, V. (2024). Using high-fidelity virtual reality for mass-casualty incident training by first responders: A systematic review of the literature. Prehospital and Disaster Medicine, 39(1), 94–105.
16. Joanna Briggs Institute. (n.d.). Critical appraisal tools. https://jbi.global/critical-appraisal-tools
17. Kman, N. E., Way, D. P., Panchal, A. R., Berezina-Blackburn, V., Patterson, J., McGrath, J., Danforth, D., & Price, A. (2025). Virtual reality simulation for assessment of hemorrhage control and SALT triage performance: A comparison of prehospital to in-hospital emergency responders. Prehospital and Disaster Medicine, 40(4), 191–198.
18. Kyaw, B. M., Saxena, N., Posadzki, P., Vseteckova, J., Nikolaou, C. K., George, P. P., Divakar, U., Masiello, I., Kononowicz, A. A., Zary, N., & Tudor Car, L. (2023). The effects of immersive virtual reality applications on enhancing the learning outcomes of undergraduate health care students: Systematic review with meta-synthesis. JMIR Medical Education, 9, e40082.
19. Liu, Z.-Y., Yu, P.-Q., Zhuo, Y.-X., & Chang, Y.-T. (2025). Implementation of virtual reality tools on paramedics: A systematic review. Journal of Paramedicine and Emergency Response, 2(6), 1–15.
20. Lochmannová, A. (2025). Exploring the role of virtual reality in preparing emergency responders for mass casualty incidents. Israel Journal of Health Policy Research, 14, 21.
21. Nordén, C., Nilsson, A., Lindström, V., & Bremer, A. (2014). Mapping the use of simulation in prehospital care: A literature review. Prehospital and Disaster Medicine, 29(2), 1–8.
22. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71.
23. Phrampus, P. E. (n.d.). A historical perspective of simulation in emergency medicine. In SpringerLink.
24. PROSPERO. (n.d.). How to register a systematic review in PROSPERO. https://www.crd.york.ac.uk/PROSPERO/help/register
25. Razzak, J. A., Kellermann, A. L., & others. (2012). Assessment of the status of prehospital care in 13 low- and middle-income countries. Prehospital and Disaster Medicine, 27(3), 230–236.
26. Ripoll-Gallardo, A., Oldrini, G., De Luca, G., Arghetti, D., Stellini, A., Zambelan, A., Fiameni, R., Colzani, G., Manzoni, P., Broccoli, F., Lolli, S., Zumbaio, F., Agarossi, A., & Fumagalli, R. (2026). Dispatch center performance and crisis resource management skills in mass casualty incidents: A prehospital simulation study preparing for 2026 Milan-Cortina Olympics. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 34(1), Article 28.
27. Rowland, J., & Adeloye, D. (2022). Knowledge and perceptions of crisis resource management among prehospital emergency care practitioners in South Africa. Advances in Medical Education and Practice, 13, 845–856.
28. Sachs, J. D., et al. (2025). Global burden of emergency and operative conditions: An analysis of Global Burden of Disease data, 2011–2019. The Lancet Global Health.
29. Sadowski, B., & Phrampus, P. E. (2023). Crisis resource management training in medical simulation. In StatPearls. StatPearls Publishing.
30. Smith, C. M., & Brown, P. C. (2023). Simulation in emergency medicine graduate medical education: A call to lead. Western Journal of Emergency Medicine, 24(2), 203–207.
31. Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., et al. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, l4898.
32. Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rücker, G., Harbord, R. M., Schmid, C. H., Tetzlaff, J., Deeks, J. J., Peters, J., Macaskill, P., Schwarzer, G., Duval, S., Altman, D. G., Moher, D., & Higgins, J. P. T. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ, 343, d4002.
33. Tactical Triage Technologies, LLC. (2025). First VResponder [Virtual reality simulation software]. Powell, OH: Author.
34. Way, D. P., Panchal, A. R., Price, A., Berezina-Blackburn, V., Patterson, J., McGrath, J., Danforth, D., & Kman, N. E. (2024). Learner evaluation of an immersive virtual reality mass casualty incident simulator for triage training. BMC Digital Health, 2(1), Article 56.
35. Weismeier-Sammer, D., Murtinger, M., & Peer, A. (2024). SURVIVE-R: Situational awareness und virtual reality-training. Elsevier Emergency, 5(2), 40–49.
36. Wells, G. A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (n.d.). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
37. Wheeler, B., & Dippenaar, E. (2020). The use of simulation as a teaching modality for paramedic education: A scoping review. British Paramedic Journal, 5(3), 31–43.
38. World Health Organization. (2023). Emergency Medical Teams 2030 strategy. World Health Organization.
39. World Health Organization. (2023). Integrated emergency, critical and operative care for universal health coverage and protection from health emergencies (WHA76.2). World Health Organization.
40. Youngblood, P., & McGrath, J. (2026). Simulation-based assessment in emergency medicine: A rapid review. BMC Medical Education, 26, Article 09505.
41. Zarifsanaiey, N., & Mehrabi, M. (2025). Enhancing pediatric emergency care in low-resource settings through simulation-based training: A narrative review. Cureus, 17(3), e12220881.
42. Zendejas, B., Wang, A. T., Brydges, R., Hamstra, S. J., & Cook, D. A. (2013). Cost: The missing outcome in simulation-based medical education research: A systematic review. Surgery, 153(2), 160–176.
43. Zhang, Z., Meybodi, M. M., Ingale, A., Karimova, L., & Vinnikov, M. (2025). Extended reality technology for emergency medical service training: Systematic review. Frontiers in Disaster and Emergency Medicine, 3, 1630167.