A Picture-based Serious Game to Train Non-medical People for Emergency Situations

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A Picture-based Serious Game to Train
Non-medical People for Emergency Situations
Stephane Gobron
Engineering School of HE-Arc
University of Applied Sciences Western Switzerland (HES-SO)
Neuchatel, Switzerland
stephane.gobron@he-arc.ch
Sylvie Chatelain
Grangette Early Childhood Institute
Lausanne Children Day-care Reception Service
Lausanne, Switzerland
sylvie.chatelain@lausanne.ch
Christophe Bolinhas
Engineering School of HE-Arc
HES-SO
christophebolinhas@gmail.com
Domingos Correia de Oliveira
Health School of the canton of Vaud (HESAV)
HES-SO
Lausanne, Switzerland
dominique.correiadeoliveira@hesav.ch
Abstract—Asanon-medicalprofessional,reactingtoanemer-
gencysituationwherelifeisatstakeisnotaneasytask:knowing
theminimumproceduretoreacttosuchasituationisaquestion
thatmostpeoplejustcannotanswer.Thispaperproposesa
seriousgameusingasimplepicture-basednavigationwhich
providesatrainingtoolforcommonpeople.Thisseriousgame
wantsaboveallthateveryonecanfullyknowthefourpriorities
ofaction:(1)keepcalm,(2)evaluatethesituation,(3)identify
thedangers,and(4),callforhelp.
Forpracticalpurposes,thedomainofearlychildhoodhasbeen
selectedtotraineducatorsforfivet ypicalm ajora ccidentsthey
willprobablyencounterwithchildren.Twooftheseaccidents
werefullydeveloped,parameterized,andtested.Thispaper
focusesare:first,onthemedicalandsocialneeds,demonstrating
howimportantfirst-witnessreactionsareinanemergencyscene;
second,onhowdifferentdomainexpertsandprofessionalswere
broughttogether;third,onhowthesoftwarewasdevelopedbased
onaneducator-centereddesign.Resultintermsofimage-based
interfaceandusertestsshowthataapplicationwithoutfantastic
graphicsandspecialeffectscanhavearealimpact:potentially,
animpactonpeople’slives.
IndexTerms—Seriousgame(SG),Picture-basedapplication,
Emergencysituation,Childhood,Kindergarten,Educator
I.INTRODUCTION
Thispaperpresentshowalow-costphoto-basedserious
game(SG)canhelpnon-medicalexpertsrespondtoemer-
gencysituations.AsillustratedinFig.1,thispaperconcerns
threedomains:(1)healthcare,forthemedicaladviceand
officials ystematicp roceduresgivenbythec entralc allser-
vice;(2)education,astheapplicationdomaininvolveslarge
groupsofyoungchildreneducators;and(3),engineering,for
thesoftwareapplicationdevelopmentandgametechnology
advice.Thefollowingsectionsintroduceeachdomaincontext:
Healthcare,Social,andEngineering.
Engineering
Serious game dev.
E
E
S
n
Se
E
E
S
Social
Kindergarten
This project
ÆEmergency situaƟon advice
ÅDevelopment proposals
ÆUser pro Įle advice
ÅUser tests
ÆEmergency situaƟon
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ng
E
E
n
E
E
Health
Emergencies
Fig. 1. General presentation of the three domains involved to develop a
functional serious game (SG) application to train young child educators for
emergency situations.
A. Healthcare context
Everyday life accidents during the early childhood are a
major public health problem as they are the leading cause of
accidental infant mortality [11], [12]. Professionals in charge
of children often find it difficult to estimate the accident risks
related to the child age because they often misunderstand
the prevention technical means. In 2013, according to the
American National Center for Injury Prevention and Control,
an estimated 8.3 million children, aged 19 and under, were
seen in emergency departments for non-fatal unintentional
injuries, with an injury rate of 10.0 per 100 children, and seven
thousand children, aged 19 and under, died from unintentional
injuries, the death rate being 9.3 per 100,000 children [22].
Considering the recommendations for collective children
day care in Vaud canton, Switzerland, the knowledge and
implementation of emergency procedures should be ensured
by a continuous training of the employees. The management
of each nursery should organize specific training sessions to
manage first-aid situations in order to ensure an adequate
knowledge level. We thus wanted to understand if the use of a
technological tool like a SG would ease the learning processes
,(((
Funding:HE-Arc(HES-SO)internalfundingsystem,grantentitledSG4ER
(2015-2018).

of first-aid management. Indeed, it is possible and necessary
to do more and better and go further in the early childhood
worker training, by regular recycling and strengthening of their
skills in terms of preparation and response to save lives.
1.
Scene
understanding &
securing
2.
First
aid
3.
Emergency
call
4.
Transport
to hospital
5.
Hospital
emergency
Who?
First witness
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DĞĚŝĐĂůƐƚĂī
Where?
Community
Transport
Hospital
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Fig. 2. Pediatric Chain of Survival 2010 - AHA
Public health issues and context – How to increase
the survival chances during a life emergency? Different
studies such as [24] [15] suggest that the first links in the
survival chain (illustrated in Fig. 2) who have the mission
to alert the emergency services as quickly as possible,
taking care to specify the victim status, must be improved.
These first actions will have to be carried out by first
witnesses implying how important continuous training of
any individual, collaborator or professional can be. Indeed,
responding correctly to an emergency situation is difficult
since knowledge related to the field is not enough: scene
observation skill, initiative skills, and being able to give
relevant and accurate information to the “144” (emergency
number in Switzerland) are needed and we believe, can be
trained to anyone. Immediate initiation of cardiopulmonary
resuscitation from witnesses is the main avenue to improve
the survival rate after a cardiopulmonary arrest (CPR).
The higher the proportion of ACR patients benefiting from
first-witness heart massage, the better the overall survival will
be with a quality neurological outcome [20].
Action – Concerning the fact people must or have to assist,
it differs for each country; regarding Switzerland, Article 128
of the Criminal Code states that non-assistance to persons in
danger is punishable by law. We expect each stakeholder to
respond to the seriousness of the situation based on their skills
and level of responsibility, but at a minimum. Each witness
should be able to identify the situation and mobilize relief
appropriately through the call to the emergency number and
the transmission of targeted information hence the relevance
of the game and its added value.
Target – In addition to the efforts made to prevent
accidents and diseases, and also progress made in public
health, the needs of specific populations must be taken into
account, especially those of early childhood workers facing
daily first aid. The rescue chain partners (e.g. 144, Police, or
REGA –the Swiss Air Guard Rescue) are also working on this
weakness by trying to build tools to better understand their
interlocutors. Our approach is not to supplant current effort,
it is rather complementary. Indeed, we propose to increase
the reaction and communication skills of these interlocutors
by integrating such serious game for instance at health care
bachelor level.
Objectives – An extension could also be developed specifi-
cally for parents, as part of prevention courses set up by child-
care centres, for example. However, the emotional dimension
should be adapted: we would have an increased risk of gener-
ating anxiety among participating parents who could project
their own child, injured or worse, in the proposed situations.
Through the development of this prototype, a pedagogical
objective was also to validate the use of this technology as
a complementary strategy to the classical training on first aid.
1.
2.
3.
4.5.
6.
7.
EvaluaƟon of
scene
Securing the
envir onment
VicƟm diagnosis
Organis aƟon and
priorŝƟnjĂƟŽŶ of acƟons
Leadership - First
responder
Technical
training
EmoƟonal
management
Fig. 3. Different stages targeted by the training with this SG.
Based on the steps illustrated in Fig. 3, our priority objec-
tives to enhance the efficiency of these first links are: skill
development; observation; initiative taking; emotion manage-
ment; decision-making capacity; organization; transmission of
relevant information to the emergency controller (911 in the
US, 112 in EU, or 144 in Switzerland).
In the longer term, this project will enable to validate the
vital-emergency-management basic knowledge and integrate
this project as a new pedagogical approach into current acute
care training plans. We can imagine the hypothesis that this
game can immerse each user in a realistic scenario. Therefore,
one of the major goals of the game is to realize its needs to im-
prove dimensions such as leadership, delegation, prioritization
of decisions, management of the unexpected.
B. Social context
In their daily works, professionals supervising young chil-
dren in community must deal with several missions: educa-
tional, social, political and preventive. In this last part, the
main task is first and foremost to guarantee the safety of
the children in attendance. Extended-time facilities are open

between 10 and 12 hours a day. Most of them attend to
children from the end of their mothers’ maternity leave -
four months - to their schooling or even to the end of their
second year at school. Within a day, children live in a group of
indoor and outdoor activities responding to their great need for
discovery, experimentation and learning. Furthermore, meals,
naps, moments of care are added to playful periods.
Despite the constant concern of professionals to ensure the
children safety, there are numerous situations likely to cause
accidents. Fortunately, the majority of injuries are benign;
nevertheless, few cases require the intervention of emergency
staff, e.g. deep wounds, broken limbs, unexplained fainting,
convulsions. The Swiss Health Observatory Institute ([OB-
SAN2017]) has identified that children represent around 7%
of the total activity at emergency. We must also add all the so-
called special and therefore more sensitive reception situations
such as children with disabilities, allergies or epilepsy.
In his professional career, almost any educator will need
to call emergencies at least once. Are educators sufficiently
prepared? Do they know the essential information that must be
transmitted? Are they ready to act despite the strong emotions
that a child in distress may arouse? Unfortunately, this is not
the case for the large majority. Indeed, in Switzerland, at nurs-
ery level, professionals must certify a single day of first-aid
training, but nothing is required of teachers. Real skills relative
to emergency situations is not popular since, to be valid, it
must be refreshed at least once a year, implying heavy costs in
time and money. Furthermore, many professionals mistakenly
believe that first-aid measures can easily be controlled or that
a serious accident just never occurs.
The current SG has strong advantages, in answering these
critical issues, at least for educational professionals and we
believe it could be easily exported to any institute with a
similar structure:
•Accessible at all times to professionals within the in-
stitution. It allows a regular knowledge refreshing in a
reassuring context;
•The scenario which, without trivializing the accidents,
allows the familiarization of the right acts to pose.
The professionals are therefore better prepared to act
relevantly, as effectively as possible, in the event of an
accident;
•The results, experiences or emotions experienced through
the SG can lead to team reflections and better targeting
of sensitive points to work: emotion management, pain or
death in children, collaboration with parents or children
management in an accident situation, etc.
Furthermore, based on the impact demonstrated in our
institute, it has been demonstrated that such SG is a valuable
tool for the whole profession as it promiotes and supports: (1)
the information transmission to emergency personnel in case of
an accident and makes the injured care more efficient, (2) the
services offered and the professional posture by anticipating
and knowing the acts to be done in an emergency context, and
(3) the managerial work by pointing out essential themes to
be explored in an individual and/or collective accompaniment.
C. Engineering: the serious game states
Game-based learning is vast and a significant amount of
research had been done on its efficiency. Babu et al. [1]
demonstrated how a 3D simulation from a collaborative game
teaching how to manage post-disaster situations helped the
participants to better connect theory to practice and showed
the cost efficiency it can bring. In the case of incident triage
training, Knight et al. [7] evaluated the effectiveness of a
SG that created affordable and accessible interactive virtual
worlds. They showed that such an application enhances par-
ticipants learning and performance in comparison to traditional
educational methods. Virtual reality has been explored in
pedagogical SG for health for instance with Sisto et al. [19]
or Gobron et al. [6] respectively for an approach dealing with
musculoskeletal disorder and training for the rehabilitation
of the legs involving a head-mounted display and haptic
robot devices. Chan et al. researched how a game teaching
needle placement [3] could greatly increase the learning of
inexperienced medical participants.
As analyzed by the team at the Institute of Digital Media
and Child Development Working Group (Baranowki et al. [2]),
SGs for health often require less funding because they don’t
need to compete with AAA entertainment video games bud-
gets. Nowadays research and development for such products
are largely funded by government or foundation grants. A
study (Li et al. [8]) done in manufacturing environment show
evidence that SGs are and effective method to train procedural
knowledge in complex manufacturing scenario. Health care
procedures are as such procedural knowledge and can become
complex as well. Another study (Dieh et al. [5]) proposes
the design and development of games for specific handling
of chronic diseases treatments, for instance, based on insulin
therapy. It shows some potential in developing different game
levels for child care institutes. Notice that levels can be easily
edit directly through an XML file with a dedicated format.
Currently no localization system has been implemented but
the current structure would only require and extraction of
the current texts into a spreadsheet and the integration of an
existing localization module. Furthermore, game data would
need to be stored on the cloud to facilitate levels based on
various countries legislation.
Many SGs in health or education have been proposed. More
specifically for children, we can cite for instance Matsunaga et
al. [9] focusing on the development process of an educational
game aiming on hemophilia or Mikuszewski et al. [10] with
a serious game with therapeutic goals that focuses on issues
and problems of preschool children.
II. DEVELOPMENT STRATEGY
The work has been developed for and with social educators,
paramedical staff, and game designers. The Fig. 4 introduces
six categories of actor having participated in this project and
representing a total of more that 110 people. Here follows the
procedure to bring them together:

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2.
3. 5.
6.
4.
1.
Fig. 4. This figure presents the six categories of people for a total of 113
people involved in this project.
•Emergency experts (1.) met computer science engineers
(2.) to look for appropriate solutions during emergency
situations for none medical people;
•Both groups decided to contact educators (3.) as potential
application field;
•Educational staff (3.) confirmed their strong needs since
the children (4.) they were taking care of often had
accidents;
•A mixed group of three software developers and five chil-
dren institute directors identified ten critical situations,
based on their personal experience;
•Five scenarios were designed as a storyboard and two
were implemented by (2.): severe double fingers sectioned
and premature infant death;
•Then two groups of 30 medical students (6.) tested the
double scenario prototype and parameterized it;
•The final application was then tested by 35 educators
of 10 kindergarten sites in Lausanne (Switzerland), who
completed an anonymous questionnaire;
•Regrouped results were analyzed by (1.) and (2.).
A. User-centered design
Patient care and monitoring can be considerably improved
over time with the use of technological health devices [21].
That’s why information and communication technologies like
serious games have become an integral part of the provision
of health care: a broad range of new electronic-health (e-
Health) applications has emerged [...]. All these applications
promise patients, nurses, doctors, and administrators to ef-
ficiently access relevant health information, enhance patient
care quality, reduce healthcare errors, increase collaboration,
and encourage the adoption of healthy behaviours [23].
Those two situations already lead to a software requiring a
strong development flexibility and pushed towards the develop-
ment of a point-and-click game, allowing: (1) the management
of possible actions depending on previous conditions, (2) the
management of items, and (3) a system where the team can
quickly add new content or update it through editable files.
When managing vital emergencies, we identify stress factors
such as inexperience with first aid gestures (ability to identify
the situation and delegate, effective leadership, lack of mastery
of techniques, organizational problem, etc.) fear of error and
forgetfulness, reflection and rapid decision-making as well as
the projection of the idea of death. SG4ER aims to make
the user aware of stressful situations and help him implement
strategies to evolve such as improving time and organization
management, self-confidence development and the best control
of resuscitation techniques and equipment. To transcribe as
best as possible the feeling of emergency in the game, we
chose to let the user explore the environment by giving
minimal information. He must become aware of the important
knowledge he requires when confronted to an urgent situation,
such as the location of the pharmacy, the important items he
must gather or being able to take upon useless actions.
Furthermore, each action takes actual time and an useless
action has an added negative effect to the solving of the
situation. Finally, the call to the emergency services rises
questions that have a limited time to be answered, giving a
final touch to the stress related to giving the vital information
as fast as possible.
B. Engineering model
As shown in the previous section, this project has
been developed with user-centered methodologies (AGILE,
Scrum [18]). This methodology has been used as a fast-
iterative process to develop a minimum viable prototype
integrating all the game mechanics clinical experts needed
to convey educative content. Scrum allowed quick shifts in
direction based on multiple proof-of-concept iterations and
ensure the product felt as stressful to play as a real situation.
The app goal was to reach as many people as possible and
thus ensure a large compatibility with various machines. Qt
enabled us to develop without constrains for recent MacOS
versions and Windows XP, 7, 8 and 10. Furthermore, a
Linux version could also be released. To be able to run the
application, the user must download the installer, run it and
then run the game. The time needed to finish both available
levels amounts to about 20 playtime minutes.
C. External files
The game is mainly composed of images taken from an
actual child care center. Some pictures are meant to navigate
within the corridors and some represent scenes where the user
will be able to do actions. The application also uses icons
to help illustrate user options and sounds to make his actions
more immersive. The sounds can range from bandaging noises
to a baby crying. Some of the music is also used to set
up the scene mood and to deepen the experience. The other
important files are the level descriptors containing all the
scene configurations, options and questions. Those files put
into relation the different data of a level and enable a flexible
creation and edition of levels. The scoring files, run on a
separate file to facilitate editing, are together with the level

descriptions and they are used to compute the user’s final score
and generate a feedback to user’s different actions.
D. User profile and email feedback
At each start of the app, the user is asked to input his
email which is then used to receive a PDF file of his session
results with his different scores and feedback information.
There currently is no system saving the user profile between
launches. A short resume of the results is sent both to a
centralized email for data collection and to the email the user
inputs when starting his session. No email validation is done,
and a fake email can be used to access the program. This
system is the demonstration of the potential feedback and
monitoring system that could later be implemented.
E. The game
The two levels place themselves in a child care institution.
The user is driven through four different phases. The first one
consists of a contextualization of the level and important data
about the center location and access which include: a map of
the scene, the street name, the city, the floor and entry code
of the building. The user must remember this information
and can look it up during his play-through. Once the user
is ready, he is put at the beginning of the scene and must
explore it to find what the trouble is. He can look through
medical files, pick up items and realize various actions to
analyze and solve the situation.
At one point, the user will have to call the emergency center
that will ask him timed questions. The time limit is there to
give the emergency feeling usually given by call receptionists.
In this part, his possible answers depend on his actions in
the scene. Finally, the session ends as the player receives, by
email for privacy and back-up, his score and advice for further
improvement as a feedback. She or he will also be able to retry
the level or go back to the level selection.
One of the most critical design decisions made for the game
was tightly linked to the feeling of urgency one has in stressful
situations. Therefore, the user has access to a relatively large
list of futile or even negative actions to make him feel the
lack of external guidance you could have in those situations.
Furthermore, the game never gives signs if an action is correct
of wrong during the procedure and never lets through if the
care is actually properly finished.
F. Score analysis
A user’s play-through will amount to numerous actions
evaluated between correctness and timeliness. Each action will
impact the total level time as well as the speed at which the
user takes care of the patient. Therefore, all the user’s actions
during the session, as well as his choices during the call to
the emergency services, are analyzed by a dedicated scoring
module. The output consists of an action score, a time score,
a call score and his two best and worst actions.
The Fig. 5 summarizes the different parts of the application
and their communication with each other. Each number can
be summarized as follows:
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Fig. 5. Presentation of the application core parts and their communication
with each other.
1) Loading of the external files describing the available
levels and opening of the main menu;
2) The user selected the level and loaded the required
images, level descriptions and sounds to render the level
mood;
3) Level completion, score analysis file load and scoring
computation;
4) Email containing user’s score and feedback + level selec-
tion screen again.
The Fig. 6 presents the 10 steps of the tutorial introducing
the game structure: (1) main menu; (2) mini map; (3) inter-
face: phase I main view, reaction to emergency situation; (4)
description of the three left info window; (5) explanation on
why each action will cost time and why choice is therefore
crucial; (6) Navigation; (7) how to select and take objects,
here in the pharmacy kit; (8) interface: phase II beginning, the
emergency call; (9) procedure of official questions asked; (10)
feedback with score on amount of time spent, correct/wrong
actions, and correct/wrong answers to emergency service.
A relatively simple tutorial was implemented at this stage
regarding basic information and a detailed map is given to
the user before starting the level. Nonetheless, the current
feel of the game forces the user to actually explore, deduct
and memorize where important material is stored in the levels
facilities.
III. EXPERIMENTAL APPROACH
From an educational point of view, this proposal is a simu-
lation game based on a social constructivist model. The user,
thanks to his experience, will understand the factors involved
and the interrelations between them, with an understanding
more than a simple absorption. He becomes the actor of his
apprenticeship: simulations advocate learning by discovery
and action –i.e. learning by doing [4](page 7).
Applying his experience in different scenarios, the user
gains control of his own skills. Indeed, the goal, under these
circumstances, is the completion of a mission associated with
the role assigned to it in the scenario. In addition, this

1.
Choice
of scenario
2.
Minimap
3.
Main
interface
4.
Main action
windows
5.
Information bar on
main window top
6.
Navigation
process
7.
Taking/using
objects
8.
Calling the
emergency service
9.
Answering questions
from the emergency service
10.
Feedback
and scores
Fig. 6. Presentation of the tutorial guide in 10 steps: from main menu (1.)
to user feedback and scoring (10.).
resolution process will allow him to develop new skills such
as leadership and/or social, communication and interpersonal
skills. It is also possible to introduce the pleasure dimension in
the situations developed. This pleasure is the opportunity that
the game gives to excel, to confront challenges while having
the feeling to control the situation, but also to interact with oth-
ers to collaborate. Thus, this approach offers a privileged way
to involve the users, in particular by immersing in a realistic
universe and motivational springs such as the transition to the
next level. The desired impact is that the players appropriate
the problems designed for learning, in action. In this sense,
serious play is an experiential learning approach.
IV. RESULTS
A. Platform presentation
Even if only two scenarios were completed, the 524 pictures
(with 321 actually cleaned and used) of this SG were taken in a
single day. Samples of them are presented in Fig. 7. Their final
resolution input into the game is of 1920 by 1080 pixels. When
facing the images of the case user had to handle, the result
was surprisingly immersive considering their relatively strong
reactions. The final app remains a proof of concept helping
people that were never confronted to child care and an effective
tool for knowledge assessment. This fact demonstrates that
even a low-cost development tool can have a strong impact
allowing positive actions to be taken upon being confronted
to actual emergency cases.
Corridor to
the pharmacy
sŝĐƟŵ
0°
45°
90°
135°
180°
225°
270°
315°
360°
Corridor to
the pharmacy
Access to
ƚŚĞŵĞĚŝĐĂůĮůĞ
Fig. 7. This figure illustrates the picture taken to be able to rotate over 360
within the game.
Images of scenarios 1 and 2 are illustrated by Fig. 8 with
three sets of pictures (among 321 selected):
•Top set: these images are used in both scenarios since
they represent the environment where the player looks for
(1) information about the child (e.g. checking for allergies
or special medical conditions) and (2) important basic
medical supplies in the pharmacy (e.g. gloves);
•Middle set: four major steps from the first scenario with
(1 and 2), the discovery of the four-year-old child with
his fingers stuck in and half-sheared by the metallic door
and (3 and 4), preparation and bandage result;
•Bottom set: four possible events from the second scenario
once the baby is found unconscious in his bed (i.e. at
the beginning, the player does not know it is due to
a cardiac arrest). (1) taking the temperature; (2) using
manual breathing system; (3) checking for reaction; (4)
applying a manual cardiac massage.
B. Survey results
The analysis of the results aimed at evaluating both sce-
narios and categorizing the carried-out raw data with regard
to the different items of the five step basic questionnaire: (1)
Game relevance (quality and realism of the scenario-possible
learning); (2) Graphics (image quality); (3) Ergonomics /
navigation-handling; (4) Quality of the proposed answers; and
(5) Tutorial.

Fig. 8. Three sets of pictures from both scenarios: Environment and seeking
for basic child information or medical supplies (top); first scenario called
”Deep double-finger wound” (middle); second scenario ”Cardiac arrest in
infants” (bottom).
Totally agree
Totally disagree
Disagree
Agree
Moderately disagree
Moderately agree
Relevant
scenario
for training
Consistent
possible
ĂĐƟŽŶƐ
/ŶƚĞƌĂĐƟŽŶƐ
were
consistent
EĂǀŝŐĂƟŽŶ
was easy
Quality
of pictures
were high
I enjoyed
playing the
scenario
Scenarios
#1
and
#2
Fig. 9. This figure illustrates how users reacted to both scenarios.
The first conclusions is that the SG has been validated
as an original learning tool since it is has an impact and
its approach is relatively original. It certainly needs to be
improved, especially in terms of navigation ease, graphic
quality (adding pictures), and several more levels – at least
three we believe. Even if photographs are by nature realistic,
it remains the issue of information readability. We notice that
the second scenario was more appreciated by end-users just
by the facts that navigation was easier and a richer scenario.
Educators expressed a greater enthusiasm using this tool and
gave complete and accurate comments. Their need for contin-
uous training is probably a possible explanation. Nonetheless,
a significant part of them clearly showed some difficulty
handling this type of tool just because they are not video game
players. On the contrary, Bachelor students did not have any
problem using this tool even though they had comments on the
navigation and the tutorial; they were sensitized during their
training to work in simulation (intelligent dummy, role play
and so on) and are part of the generation of digital natives.
Totally agree
Totally disagree
Disagree
Agree
Moderately disagree
Moderately agree
I agree with
ĂƩƌŝďƵƚĞĚƐĐŽƌĞƐ
/ƵŶĚĞƌƐƚŽŽĚ
ƚŚĞƐĐŽƌĞƐLJƐƚĞŵ
&ĞĞĚďĂĐŬŽŶŵLJĂĐƟŽŶƐ
ŚĞůƉĞĚŵĞŝŵƉƌŽǀĞ
ƉƉůŝĐĂƟŽŶĨĞĞĚďĂĐŬ͗ƐĐŽƌĞƐΘĂĐƟŽŶƐ
Fig. 10. This figure illustrates how users reacted to both scenarios.
Our premise is that acquiring new knowledge in a pleasant
way, by applying the principles of gamification to the emer-
gency care process, can only improves with enthusiasm its
acquisition as well as commitment.
V. D ISCUSSION
This project has demonstrated that it is possible to enrich
and increase first-aid education through the introduction of
information and communication technologies by developing a
low cost device.
Skill acquisition can be challenging, and this educational
tool can be identified as a new pedagogical approach and
a learning tool. Nevertheless, the scenario must as much as
possible reflect situations that are encountered to properly train
the emergency response and mobilize the user. We believe,
this prototype will have to be remodelled to improve the
readability of possible actions, which will have to gain in
precision and variety. It is an exercise that should conclude
with indications to develop knowledge and a debriefing with
a health professional.

A lot of potential developments remain – Users have
considered the game as a efficient time for learning and
reflection allowing a confrontation with the reality of care
situations. This experience lets us imagine the development
potential of games around any serious health topic, combining
pleasure and learning. Furthermore, direcly based from user
comments, here follows a non-exhaustive list in terms of
software improvements:
•First of all, translating the app from French to English
•Adding the three levels, already analysed and selected by
social experts;
•Adding spherical views;
•Using web-based technologies or converting into a
tablet/mobile app game;
•Using node-based frameworks to create richer contents
with conditional dialogues, higher choice impacts, and
simpler editors for health partners;
•Increasing content diversity, especially with wrong pos-
sible actions;
•Redesigning UX and improving the spatial setting; a
Google Streetview-like system would strongly help the
user not to lose himself;
•Using gamification principles integrated within the work
ecosystem so as to increase adoption;
•Adding multiplayer mode to improve the link to real life
situations where education professionals work collabora-
tively [16].
Finally, enriching the game with a legal dimension would
allow to answer questions such as: What actions are or not
authorized or expected? What is the commitment of the
responsibility of professionals in this type of situation? This
useful perspective, however, implies the SG to be adapted to
legal frameworks of each structure, each municipality, and
each country – bringing a relatively large amount of work.
ACKNOWLEDGMENT
This work was supported by the HE-Arc (HES-SO) internal
funding system, grant entitled “SG4ER” (2015-2018). The au-
thors would like to thank all engineering and health department
students for their help, testing, and contribution during intern-
ship, configuration, and user-tests phases. Special thanks are
also due to Mrs Gutierrez Montserrat for the precious English
review of the manuscript and to Mrs. Valentine Brodard for
all the photographic shots. Finally, we would like to thank the
Children’s Day Care Service, its management, its directors
and in particular Mrs Ana Lattion and Mrs Nathalie Bigot
as well as the educator Mrs Franc¸oise Pellein for their active
participation in scenarios inspired by real facts.
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