Major Incident!

A 3D Simulation Game with AI Pathophysiology

Start

JET5 Games Engine

There are many games engines out there, but none of these quite fitted the bill for this project. This is not a running-jumping-shooting type game. Nor is it a 2D physics type game, nor a VR extravaganza, nor should it demand a high-end gaming computer. This multiplayer sim needed to be fast, efficient, and undemanding of hardware—our efforts must shine in the gameplay and the realism of the clinical management challenges.

So we created our own pseudo-3D games engine. A minimal, robust, fast, multiuser gaming environment. As a bonus we now have our own platform to use in any future simulation games.

Sim Aims & Overview

The Sim environment necessarily differs a bit from real-life with a number of trade-offs. Most timings are shortened. Simulating long walks down corridors, waiting for staff looking for and setting up equipment etc would be tedious and so we've spared you that experience. Staff movement is therefore "brisk"; and clinical interventions occur instantly—though most will usually play out over time. The in-game messaging is instant and reliable. These built-in advantages are offset by the fact that you have to think quickly and accurately. You get less time to ponder.

Every player is able to see the whereabouts of all other players and patients at all times. We could have blinded the players to this useful overview, but Incidents at the QEUH in Glasgow are represented live on a whiteboard in the Hub with staff names, whereabouts, and activities indicated by magnetic name tags and marker pen. This therefore simulates the regular distribution of this board as a mobile-phone-image to each staff member—a viable thing to do as a complex Incident unfolds.

The gameplay includes the following aspects of Major Incident management by a team of anaesthetists.

DYNAMIC RANDOMISED INCIDENTS. All five core Major Incident injury types are simulated. The finely-detailed randomisation means that no two patients will ever be exactly alike. Affected patients typically arrive to A&E in waves. Each patient is allocated a number as they arrive. The A&E medics perform a primary survey and communicate their findings. They also put in a peripheral IV line, give oxygen by facemask, and attach basic monitoring. They continue to observe the patient in A&E and alert the Anaesthetic Coordinator of any deterioration. The anaesthetists take over all further clinical decisions and management. Surgical operations are automated.

Incident size is pseudo-random and will vary with the number of players. Numbers and severity of injuries are designed to stress but not overwhelm the players.

STAFF COORDINATION. One player would normally assume the role of coordinator (optional). To send a message to any individual player just click on their avatar and type the message. Click on your own avatar to send a message globally to all other players. It is up to each player to decide how to act on received messages, and whether and how frequently to keep others informed of their actions and findings.

PATIENT PATHO-PHYSIOLOGY. Some nifty AI here. Injured patients deteriorate clinically in various ways which may be life-threatening. This may happen gradually or suddenly. You can protect the patient from, or treat each complication using...

MEDICAL MANAGEMENT. Stand beside a patient and you will see their clinical monitor screen. You can click on the ACTIONS button to access a wide range of clinical interventions. As well as airway manoeuvres, fluids, stat drugs, infusions, etc, these include taking a patient for CT Scan, to theatre for surgery, or to HDU/ITU where they can be left under medical / nursing care and monitoring. You need two anaesthetists (plus an AI nurse) to do effective CPR, all other interventions can be initiated by a single anaesthetist.

SIMULATION PHASES.

• Staff "join" the on-site team and assemble in the Hub. All given a summary of what is known about the incident.
• The first wave of patients hits A&E, game on! A&E primary survey reports are sent to all staff.
• Coordinator may ask staff to go to A&E, or they may decide to go independently.
• Staff can attend any patient and make a clinical assessment, then initiate management or ask for advice or help.
• Patients may be taken to the CT Scanner for more info (join the queue, only one at a time).
• Patients may be taken to theatre for surgical management (ask the relevant surgical team to attend, they will meet you in theatre).
• Patients may be taken to HDU for care and monitoring.
• At any time a patient may deteriorate (triggering an alarm) or a further wave of patients may arrive in A&E from the incident.
• The Coordinator role involves deploying staff and maintaining overall control.
• Once the incident is over, and the medical management of all patients is finished the incident is declared completed and stops.

DEBRIEF. A detailed debrief is provided. Each patient's management is assessed for accuracy and timeliness of interventions, and a judgement made whether the clinical outcome may have been compromised. An overall Team Score is provided.

HALL OF FAME. Of course there will be this! Large Major Incidents of equivalent clinical challenge will have Team Scores listed in the Hall of Fame. High scores will not be easily achieved—you will earn your ranking!

To Do

• sign in / join / allocate ID / handshaking with client
• patient positioning
• movement "social distancing" aka final position nudge
• proximity to patient show monitor / action window