Content uploaded by Tzu-Chi Wu
Author content
All content in this area was uploaded by Tzu-Chi Wu on Jan 12, 2023
Content may be subject to copyright.
Contents lists available at ScienceDirect
Australasian Emergency Care
journal homepage: www.elsevier.com/locate/auec
Literature review
A scoping review of metaverse in emergency medicine
Tzu-Chi Wu
a,b,⁎
, Chien-Ta Bruce Ho
a
a
Institute of Technology Management, National Chung-Hsing University, Taichung, Taiwan
b
Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
article info
Article history:
Received 27 April 2022
Received in revised form 2 August 2022
Accepted 2 August 2022
Available online xxxx
Keywords:
Metaverse
Emergency medicine
Virtual reality
Augmented reality
Mirror world
Lifelogging
abstract
Background: Interest in the metaverse has been growing worldwide as the virtual environment provides
opportunities for highly immersive and interactive experiences. Metaverse has gradually gained acceptance
in the medical field with the advancement of technologies such as big data, the Internet of Things, and 5 G
mobile networks. The demand for and development of metaverse are different in diverse subspecialties
owing to patients with varying degrees of clinical disease. Hence, we aim to explore the application of
metaverse in acute medicine by reviewing published studies and the clinical management of patients.
Method: Our review examined the published articles about the concept of metaverse roadmap, and four
additional domains were extracted: education, prehospital and disaster medicine, diagnosis and treatment
application, and administrative affairs.
Results: Augmented reality (AR) and virtual reality (VR) integration have broad applications in education
and clinical training. VR-related studies surpassed AR-related studies in the emergency medicine field. The
metaverse roadmap revealed that lifelogging and mirror world are still developing fields of the metaverse.
Conclusion: Our findings provide insight into the features, application, development, and potential of a
metaverse in emergency medicine. This study will enable emergency care systems to be better equipped to
face future challenges.
© 2022 The Author(s). Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.
CC_BY_NC_ND_4.0
Contents
. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
. Materials and methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
. Goal and research questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
. Research protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
. Eligibility criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. Information sources and search strategy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. Selection of sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. Data charting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. Synthesis of results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
. AR and VR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
. AR and VR in education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
. AR and VR in prehospital and disaster medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
. AR and VR in diagnosis and treatment application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
. AR and VR in administrative affairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
. Mirror world . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
. Lifelogging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
. Potential of the metaverse in the four extracted thematic categories in emergency medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
https://doi.org/10.1016/j.auec.2022.08.002
2588-994X/© 2022 The Author(s). Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.
CC_BY_NC_ND_4.0
⁎
Correspondence to: National Chung-Hsing University, Institute of Technology Management, 250, Kuokuang Road, Taichung 402, Taiwan.
E-mail addresses: j10062008@hotmail.com (T.-C. Wu), bruceho@nchu.edu.tw (C.-T.B. Ho).
Australasian Emergency Care xxx (xxxx) xxx–xxx
Please cite this article as: T.-C. Wu and C.-T.B. Ho, A scoping review of metaverse in emergency medicine, Australasian Emergency Care,
https://doi.org/10.1016/j.auec.2022.08.002i
. Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
. Prehospital and disaster medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
. Diagnosis and treatment application. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
. Administrative affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Ethics approval and consent to participate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Consent for publication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Author contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Competing interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Introduction
The term “metaverse” was coined in 1992 by Neal Stephenson in
the science fiction novel Snow Crash. It consists of the prefix “meta,”
meaning “transcendence and virtuality,” and the stem “verse,”
meaning “world and universe.” Metaverses are immersive, colla-
borative environments that are three-dimensional and real-time
virtual worlds where multiple users conduct social, economic, and
cultural activities and interact with each other through avatars and
their environment without any physical separation [1,2]. Although
the metaverse was introduced 30 years ago, there has been limited
improvement in it. This is because of the technical challenges in the
processes of communication, shared understanding, and coordina-
tion [2].
Many industries have adapted to the metaverse phenomenon,
including the healthcare industry in 2021. In health industries, sev-
eral trends in technological developments, such as artificial in-
telligence, machine learning, blockchain, and personal big data,
enhanced the role of digital assistants’ ubiquitous distribution [3].
The growing role of a metaverse in several fields because of the
emergence of technical improvements such as the brain-computer
interface has fostered capabilities that support interpersonal re-
lationships and improve the execution of virtual projects.
To monitor the emerging trend of the metaverse and understand
its potential application in the future, we aim to evaluate its ap-
plicability in the emergency medicine field. However, there has been
little research and information on the metaverse. Only 40 results
were retrieved from the PubMed database in May 2022 when the
search term “Metaverse” was entered. Hence, to our knowledge, we
conducted a scoping review, the first report of a metaverse in
emergency medicine. The scoping review of current studies is es-
sential, considering the potential impact of the metaverse on the
future healthcare system. We explored information from the meta-
verse roadmap relating to the basic concepts of four types of me-
taverse: augmented reality (AR), lifelogging, mirror world, and
virtual reality (VR), aiming to assess the status and applications of
these technologies in emergency medicine.
Materials and methods
The Acceleration Studies Foundation created the metaverse
roadmap using two dimensions to explain the four types of the
metaverse [4]. We kept the classification and modified the axes with
previous studies to examine metaverse in the context of emergency
medicine [5] (Fig. 1).
There are three axes with the four types of the metaverse. The
first axis is augmentation versus simulation. Augmentation tech-
nology enhances human sensing or adds new functions to a real-
world environment through stimuli. In contrast, simulation tech-
nology imitates the world to provide a unique environment by
modeling reality. The second axis is intimate versus external. The
intimate metaverse focuses on personal behavior and individual
data. Thus, the external metaverse focuses on the surrounding
world, and the external reality is centered on the user [6]. The last
axes are real and virtual worlds, the opposite ends of a continuum.
The real and virtual worlds focus on the environment, consisting
solely of real and virtual objects [5]. AR is real-world augmentation
achieved by integrating real and virtual worlds into a single unified
reality, whereas VR creates a simulated environment entirely dis-
tinct from normal reality.
Goal and research questions
To ensure that a substantial range of literature was captured
relating to the topic of interest, we posed the following initial re-
search questions to guide the search:
(1) What areas have been addressed in current applications of me-
taverse technology in the emergency health care domain?
(2) What techniques of metaverse are most used in the emergency
health care system?
(3) What are the current conditions and reasons for using metaverse
techniques in the emergency health care system?
(4) What is the potential for metaverse development in the emer-
gency health care system?
Research protocol
A scoping review was considered to get insight into metaverse's
current development and application in emergency medicine. This
review is reported according to the Preferred Reporting for
Systematic Reviews and Meta-Analysis Extension for Scoping
Reviews guidelines with the PRISMA-ScR checklist [7]. The regis-
tration number of the review protocol is INPLASY202250159.
Fig. 1. The four types of the metaverse (Modified from Paul, 1995[5] and John,
2007[4]).
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
2
Eligibility criteria
To be included in the review, papers were required to report on
aspects of metaverse technology as applied to fields of acute medi-
cine. Papers were included if they were published in journals or
conference proceedings, including reviews or position papers, irre-
spective of the maturity level of each published work. Papers were
excluded if they did not fit into the study's conceptual framework or
if they reported on metaverse technology in the context of an ap-
plication not directly related to health care.
Information sources and search strategy
We performed our PubMed search on January 15, 2022, using AR,
VR, emergency medicine, lifelogging, and mirror world, separately.
The search terms were as follows: 1. (Augmented Reality) AND
(Emergency medicine), 2. (Virtual Reality) AND (Emergency
Medicine), 3. (Lifelogging), and 4. (Mirror world). The final search
results were exported into EndNote, and duplicates were removed.
Selection of sources
The authors independently screened the titles and abstracts of all
publications and excluded publications with no abstract, no full
texts, and no English delivery, as well as publications not related to
metaverse or the emergency medicine domain. Subsequently, the
two reviewers studied the texts independently and in detail to de-
termine whether they met one of the following criteria of research
focus: (1) metaverse in emergency medicine; (2) AR in emergency
medicine; (3) VR in emergency medicine; (4) lifelogging in emer-
gency medicine; and (5) mirror world in emergency medicine.
Articles not focusing on emergency medicine were excluded (Fig. 2).
Data charting
Two reviewers examined the retrieved articles and recorded in-
formation using a predetermined form that two reviewers jointly
developed to determine which variables to extract. The following
data items were extracted: study type, published time, technology
type, and application in emergency medicine.
Since we did not manage to identify scoping reviews on the same
topics as the research questions, we opted for a topic-specific al-
ternative for the classification of papers. Through the content ana-
lysis process, a concept and its application were identified and used
to construct a classification scheme. In the process, data items re-
presenting categories were merged or renamed through discussions.
Finally, the following four additional classifications were extracted:
education, prehospital and disaster medicine, diagnosis and treat-
ment application and administrative affairs.
Synthesis of results
We analyzed the overall results of existing literature regarding
the metaverse in the emergency medicine domain. The Sankey
diagram depicts the amount of research and relationships. Then, we
summarize and discuss the findings for each metaverse concept.
Finally, we provide insight into the potential of the metaverse for
each of the identified areas.
Results
A total of 628 articles were identified and categorized as AR
(N = 297), VR (N = 242), lifelogging (N = 80), and mirror world (N = 9).
Then, 628 articles were reviewed according to the inclusion and
exclusion criteria, and 112 remained. Among these selected items,
the most common article types were pilot studies (n = 44), followed
by random randomized controlled trials (n = 25), proof of concept
studies (n = 14), review articles (n = 12), metanalyses (n = 1), experi-
mental studies, conferences, and others. (n = 16).
Finally, four thematic categories were identified by two re-
viewers: education (N = 55), prehospital and disaster medicine
(N = 27), diagnosis and treatment application (N = 25), and admin-
istrative affairs (N = 5). The four types of metaverse, in descending
order, are VR (N = 75); AR (N = 32), mirror world (N = 3), and life-
logging (N = 2). Our review of 75 articles about VR revealed the wide
application of VR in education (N = 36), followed by prehospital and
disaster medicine (N = 18), diagnosis and treatment application
(N = 17), and administrative affairs (N = 4). Our review shows that VR
simulators are available in various sizes and shapes, and Oculus
Quest is the most used. Further, a review of 32 articles on AR re-
vealed wide application in education (N = 18), followed by pre-
hospital and disaster medicine (N = 8) and diagnosis and treatment
(N = 6). Most of the studies used Google Glass and Microsoft
HoloLens.
The Sankey diagram revealed the flow between metaverse
technology and the four identified thematic categories (Fig. 3). Fi-
nally, the result of the metaverse roadmap demonstrated that edu-
cation is the main classification of applications for the metaverse. AR
and VR are the main application technologies, with research on VR-
related studies surpassing AR-related studies in emergency medi-
cine. Lifelogging and mirror world are still developing fields of me-
taverse (Fig. 4).
In this extracted education classification, learning procedural
skills with AR includes central line insertion [8], airway manage-
ment, and ultrasound learning simulation [9]. The concept of AR
ultrasound simulator, which uses contextual in situ visualization of
ultrasound slices simulated from computed tomography, is utilized
for clinical training and simulation [9]. AR is also being increasingly
applied and studied in resuscitation training programs. These pro-
grams provide high-quality chest compression using the AR cardi-
opulmonary resuscitation (CPR) training system [10], CPR refresher
training course [11], and pediatric septic shock simulations [12].
Also, VR plays a role in intubation [13,14] and surgical airway
training, obstetric forceps delivery, and ultrasound. In ultrasono-
graphic training, VR can support learners in developing spatial re-
lationships and realistic anatomical structures through immersive
and interactive experiences [15]. Conventional CPR training has
limitations because it lacks realism and immersion. VR is one solu-
tion that establishes a virtual educational environment and provides
trainees with a sense of realism that has already been used in CPR
training [16]. Furthermore, it is a potentially powerful tool for fos-
tering and improving bystander intervention. It includes calling the
emergency services (911 or other local emergency numbers) and
asking for an automated external defibrillator for sudden cardiac
arrests [17,18]. In critical care education, VR-based training in dia-
betic ketoacidosis and status epilepticus has boosted the confidence
Fig. 2. PRISMA-ScR flow diagram.
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
3
of those managing critical patients and facilitate positive changes in
their practices [19,20]. Also, VR has played a crucial role in COVID-
19-related skill training that includes collecting nasopharyngeal
swabs and donning/doffing personal protective equipment and is
considered a helpful tool for acquiring simple and complex clinical
skills in Japan [21].
In this classification of diagnosis and treatment application, the
number of studies in VR exceeded AR. However, AR can provide
medical support to emergency physicians in daily operations, e.g., to
overcome the challenge of rare events in a pediatric emergency, an
assistance service with an integrated AR emergency ruler was ap-
plied for size measurement and calculation of dosages of drugs such
as amiodarone [22]. AR also has a vital role in trauma evaluation and
management. Brain concussion assessment through accelerometry
measurements obtained from the head with the help of smart
glasses provided an objective assessment of concussion symptoms
[23]. In the case of a difference of opinion between patient and
health provider goals regarding information and education for spe-
cific diseases, AR can be used to explain each piece of information
and the relevant treatment plan so that the patient understands.
Mixed reality is used in patients with myocardial infarction to ensure
optimized knowledge transfer that enhances medication adherence
and improves recovery [24].
Regarding VR application, 16 out of 17 studies focused on pain
control, including 14 on children and two on adults. The remaining
study was a randomized controlled pilot study that used VR for
posttraumatic stress disorder symptoms following a traumatic event
in the emergency department, which revealed no significant differ-
ence between the intervention and control groups [25].
Only four articles categorized under administrative affairs were
identified. One example related to the evaluation of emergency
medicine applicants; VR, as an interview technique, allowed inter-
viewers to gain insight beyond the traditional paperwork and face-
to-face interaction [49]. Another example was the development of a
virtual emergency department to get insights into strategies for
managing patient flow [26].
Discussion
This section discusses the four types of the metaverse and their
development.
AR and VR
AR is a real-time interactive experience of a real-world en-
vironment through digitally generated three-dimensional re-
presentations integrated into real-world stimuli and existing reality
[4]. It features the fusion of real and virtual worlds into a single,
immersive, and unified reality. Google Glass and Microsoft HoloLens
are the instruments most commonly used. Google Glass focuses on
technology that runs on almost all smartphones. Still, the HoloLens
is moving toward depth sensing that can recognize and interact with
the environment and recognize human gestures, the latest trend in
AR [22]. VR is an interactive three-dimensional computer that gen-
erates a simulated environment, completely segregated from normal
reality, where people can interact using special equipment. It pro-
vides an immersive, interactive experience for users similar to their
daily life experience, and this realization of presence has potential
for application in the healthcare system.
AR and VR in education
The learning ways are changing with the rapid development of
new technologies. The focus is on providing efficient and quick ac-
cess to high-quality knowledge. Several studies have shown the
potential of AR in bridging the gap between achieving skills required
in the real-world, high-pressure environment and training in a vir-
tual environment, which enables time- and cost-effective in-
dependent learning and increases learner engagement [28].
However, there is still a lack of studies and evidence about
Fig. 3. The Sankey diagram, with cluster order by size, revealed four types of the metaverse in four thematic categories.
Fig. 4. Metaverse roadmap with thematic categories in current emergency medicine.
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
4
evaluating learning performance, integrating augmented reality
with independent learning, and assessing the effectiveness of tra-
ditional methods [29].
VR technology is used in many medical specialties, including
emergency medical education training for various tasks and colla-
borations. The virtual environment allows various life-threatening
clinical scenarios and cases to be repeated in a safe, reproducible,
immersive, and interactive setting. In emergency medicine, learning
procedural skills is vital, as is performing routine CPR simulation,
and perfecting clinical management is very important. Therefore,
high-fidelity, simulation-based education and assessment are in-
creasing in emergency medicine. Studies revealed its advantage in
overcoming the limitations of practical education, which has a po-
sitive effect on learner satisfaction and learning ability [30]. In the
future, further research can identify relevant applications, best
practices, and optimal technologies and help evaluate performance,
allowing greater focus on the acceptance of technology and the es-
tablishment and integration of training systems [31,32].
AR and VR in prehospital and disaster medicine
AR and smart glasses have proven to offer useful techniques in
disaster medicine [33]. The application of smart glasses in triage
during a mass casualty incident led to digital capture of the triage
results, which provided tactical advantages compared to conven-
tional approaches and even supported the decision-making and
speed up processes [33,34]. Furthermore, it improves the operators’
performance and helps them make better choices. [35] Similarly, VR
technology is applied in many fields in disaster medicine, including
education, professional training, mental health, etc [36,37]. VR-si-
mulated environments help medical providers regularly respond to
often chaotic settings such as high-acuity and low-frequency dis-
asters rather than have their skills atrophy from the rarity of such
events [38]. Triage skills training is studied the most. In some stu-
dies, the VR method of teaching, learning, and testing the abilities
for assessing mass casualty triage was found to be as efficient as
clinical simulation [39–41]. It is also needed in prehospital use to
evaluate the quality of CPR. The driving patterns compiled during
ambulance transport revealed that compression depth was shal-
lower in speed bumps and sudden-stop sections, although further
clinical significance remains to be determined [42]. Disaster medi-
cine training usually includes large-scale, real-life exercises, which
are resource-intensive and expensive. VR seems to have more ad-
vantages than AR, which not only creates highly realistic, instant
feedback within an interactive setting but also reduces cost and
provides a stable and reproducible scenario [37].
AR and VR in diagnosis and treatment application
AR can provide medical support to emergency physicians in their
daily operations. Although there is a great variety of studies, most
are still in the early stages of research, while some do not apply to
real-time patient management. However, it is apparent that in the
future, the range of applications in this field may be more compre-
hensive when compared to VR. In contrast, VR enables users to feel
immersed, similar to how they feel in daily life situations. This sense
of presence has a variety of potential applications that include im-
proving mood, overcoming situational anxiety, and increasing pain
tolerance [43]. Therefore, VR interventions have been used the most
in treating neuropsychiatric disorders such as schizophrenia and
autism [44]. In this classification, VR seems to have more research
than AR, but the variety is limited. Pediatric pain and its manage-
ment are challenging for the workforce in the emergency depart-
ment. VR has been studied and identified as an effective and
adequate tool that can significantly reduce the fear of pain, whether
needle-related procedural pain, laceration repair pain, or other, as
well as anger and anxiety levels [45–49]. VR application is rare in
this thematic category, which may be due to the features of the
technology. Further research may focus on different applications, not
only pain relief in various etiologies. Virtual reality education pro-
grams for specific diseases seem possible. VR may be applied as a
tool to better prepare patients for disease knowledge, medical pro-
cedures, and health education through the development of VR vi-
deos, which are effective in reducing anxiety, and stress and
increasing the efficiency of doctor‑patient communication [50].
AR and VR in administrative affairs
This thematic category focused on administrative affairs, such as
managing costs and the workforce. No AR articles were identified
related to the application of administrative affairs. However, ap-
plying VR to gain insights into strategies for managing patient flow
was seen as a great opportunity; a virtual emergency department
was developed, comprising a hybrid simulation that combined a
virtual environment, technical skills simulation, simulated patients,
and caregivers. It seemed realistic, with no significant difference
from the real world. The users were represented as characters called
avatars that interacted with each other and the environment. The
model explored effective factors, quality of care, and patient safety in
overcrowding [26]. This model was close to the metaverse since the
virtual scenario of the emergency room was the same as the real
world, called the mirror world.
Mirror world
The mirror world is the depiction of the real world in digital form
[51]. It is a simulation of the external world that offers accurate real-
world structures and human environments transferred to VR as if
reflected in a mirror [51]. Microsoft Virtual Earth and Google Earth
are examples of mirror worlds.
Our review has few applications of the mirror world in emer-
gency medicine. Alina et al. demonstrated that it was effective for
teaching emergency medicine using 360-degree video during the
COVID-19 pandemic [52]. Immersive videos are recorded using
omnidirectional cameras that help students learn the basics of
emergency care. These 360-degree video scenarios try to emulate
the on-site training sessions to overcome the rule of social distance
during the COVID-19 period [52]. This concept is identical to the
metaverse, with scenarios similar to the real environment and ava-
tars (created digital representations controlled by users) that can
interact with each other. The technique also lets students experience
surgical procedures as if they were present in the operation room
without time restriction [51]. With the technology features and
current development of the mirror world, two classifications, spe-
cifically education and prehospital and disaster medicine, may have
more potential in the coming years. However, the practical appli-
cation and research of the mirror world are still limited, and there is
still a gap in making such dreams come true.
Lifelogging
Lifelogging is a technology that acquires the digital record of an
individual’s personal experiences by capturing, storing, and sharing
multimodally through digital sensors [53]. It is considered similar to
an automated biography that offers information and knowledge
about how we live our lives. With the convergence of technologies,
advancements in sensing technology, and reduction of costs, the
emergence of lifelogging has become a mainstream activity. Wear-
able sensors and devices are the concepts of lifelogging used to trace
life activities better to understand human physical condition and
performance in daily life [54]. Personal collection of one’s health
information, including health-related daily activities, dietary
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
5
records, daily step counts, blood pressure, and body weight, via re-
cording through a wearable device and mobile apps is successful in
improving lifestyle behavior [55]. The continuous or discontinuous
biological signals such as electrocardiogram and electro-
encephalogram, recorded by wearable devices, reveal vital in-
formation about the patient’s health. They provide necessary
assistance in times of ominous need, which is crucial for diagnosis
and treatment [56]. Patient-generated health data are essential for
clinicians to manage chronic and acute diseases and engage patients
more rapidly and actively. One example is its combination with the
Internet of Things (IoT) technique that enables wireless, interrelated,
and timely health data and information to provide medical care with
precision [57].
Thus far, lifelogging is mostly used to control chronic diseases
that occur daily and helps improve the quality of life. It has a wide
application in emergency care once the healthcare system allows the
connection to and transfer of personal data (through IoT). After
overcoming the technological challenges, it may promptly provide
clinical data such as compliance related to medicine, initial heart
attack rhythms, and patterns and scenarios of syncope or seizure
attacks to the emergency physician. With the technology features
and current development of lifelogging, diagnosis and treatment
application classification may have more potential in the coming
year. However, the privacy risks and security considerations about
personal data are concerning. Further study of privacy risks pro-
tection, data encryption, and data storage would benefit the ongoing
development of lifelogging technology.
Potential of the metaverse in the four extracted thematic
categories in emergency medicine
Combined with current reviews and technological features of the
metaverse, we try to draw a picture of a potential metaverse in acute
care medicine (Fig. 5).
Education
Education is the main field of application for both AR and VR.
Emergency medicine is an early adopter of technology-based edu-
cation tools, because of the need for skills and ability to adapt to a
variety of emergent clinical scenarios [57,58]. AR and VR integration
into clinical training may be an effective educational strategy that
enhances skills and knowledge learning and improves the experi-
ence in a simulated environment. Therefore, the trend of the me-
taverse in emergency medicine education, especially resuscitation,
will be carried forward because of its applicability in teamwork
learning, decision-making, and high-stress immersion resuscitation
experience. We believe that the application of AR and VR in educa-
tion will continue to grow, and the latter has more potential because
it reduces the need for real-world stimuli. Furthermore, the concept
of the mirror world is also being explored, and it may emerge as
popular once the cost and technique are finalized. By actively uti-
lizing the characteristics of the metaverse, a higher degree of
freedom and a greater variety of environments will be provided for
creating, sharing, and learning, not only for students but also for
teachers.
So far, its effectiveness compared with traditional educational
methods is still equivocal in some studies, and further research with
a larger sample size needs to be conducted to understand the fea-
sibility and effectiveness of such a curriculum [59]. Furthermore,
future studies can attempt to characterize the best uses for AR/VR,
analyze the positive and negative effects on students' learning ac-
tivities, and incorporate the findings into conventional medical, and
educational methods in a better way. Moreover, emergency physi-
cians and emergency medicine societies should become more in-
volved in metaverse technology development and assessment,
promoting simulation platforms across specialties through inter-
disciplinary and multi-team collaboration [60].
Prehospital and disaster medicine
The number of prehospital and disaster medicine studies plays a
crucial role in our review. Disasters are an inevitable truth of our life,
prompting us to be prepared for the future. The immersive, low-cost,
and replicable features of VR technology will better equip the
healthcare system to withstand disastrous impacts in the future.
Triage skills training is studied both in AR and VR. Gradually, health
providers are focusing on training for optimized decision-making
and action-taking during mass casualty incidents [61,62]. The ad-
vancement of technology in the mirror world will have vast potential
as the virtual world is synonymous with the daily environment and
will be helpful for disaster simulation and preparation. However,
most simulation training systems still have deficiencies in their
application experience. The most common barriers are efficacy
evaluation and privacy concerns. The lack of evaluation functions
means an inability to determine the level of skill acquisition, and
corresponding privacy protection research is urgently needed to
reduce privacy leakage [63].
Diagnosis and treatment application
This extracted thematic category in emergency medicine has
fewer applications than other subspecialties. However, this classifi-
cation's applications will greatly increase, especially in AR and life-
logging, once the technology advances. There has been diverse
research on emerging concepts and applications of AR that are
novel; however, most are pilot studies and need to be explored
further. VR interventions are emerging as promising tools in acute
pain management, especially in pediatrics [46,64]. VR will be a po-
tential tool for information transfer and communication about dis-
ease knowledge, medical processes, and health concept education in
emergency care practice. Thus, we may assume that AR has more
potential and applied value in the future because of its capability to
integrate with real-world stimuli and existing reality in clinical
practice. So far, the effect in clinical management is still limited, but
some techniques seem to benefit physicians, although more appli-
cation and evidence are needed in the future.
The healthcare lifelogs can efficiently explore valuable results
from big data as they collect real-time data of various types from
individuals. Still, health providers in acute care do not yet seem to
benefit [65,66]. Much research has been conducted in recent years to
discover different lifelogging attributes, but most current surveys are
not very comprehensive, being limited to a single aspect. There is
significant potential for lifelogging to be used within healthcare to
enhance current practices [67]. It can provide clinical data, such as
Fig. 5. Potential of the metaverse in emergency medicine.
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
6
medical compliance, the rhythm of heart attack, and pattern and
scenario of syncope or cerebrovascular accident, via its wearable
devices once the technological challenges are overcome. With the
growing trend to broadly adopt wearable devices and the rapid
progression of IoT and big data science, lifelogging will soon play an
essential role in clinical practice for acute medical care.
In the foreseeable future, healthcare systems will capture, ana-
lyze, and store personal data in some external gimmick, which may
raise ethical and legal questions [3]. Privacy is still a top concern
since the user’s loss of autonomy and data might result in in-
dividuals being taken advantage of by commercial entities and
governmental agencies. In future research, it will be necessary to
explore clinical relevance and evidence, especially regarding privacy
[65]. It would also be advisable to expand the study of such devices
to consider acceptability among people who are not acutely ill, in-
cluding those with systemic risks such as heart disease and hy-
pertension.
Administrative affairs
Metaverse opens many possibilities by providing a space for
modern social communication, fresh experiences with high immer-
sion, and a high degree of freedom to work and create [26,27].
Therefore, work performance, process improvement, resource ap-
plication, and workforce management are related issues in all in-
dustries, including healthcare. Long-term issues with overcrowded
emergency departments may be solved via VR simulation and ad-
justment. With the development of the metaverse, more solutions
will be forthcoming. For metaverse to be effective, implementing
technology-driven applications will require organizations to de-
velop, support, and iterate clinician, nurse, technology team, and
system workflows for continued acute healthcare improvements [2].
Limitation
In this study, we conducted a scoping review to investigate the
potential impacts of the metaverse in emergency medicine.
However, regarding the practical application of metaverse, the
technology still has identifiable limitations and deficiencies in
system equipment, clinical implementation, evaluation functions,
etc. Therefore, the current application range is not very broad, and
related studies are rare. Although most healthcare providers and
researchers have high expectations, significant challenges face the
large-scale adoption of the metaverse. This is because of various
limitations regarding technical skills, cost, and regulatory and
privacy concerns.
We collated current research and attempted to explore a poten-
tial paradigm shift in the future emergency care system. However,
the methodological choices led to limitations in the research pro-
cess, including the use of search string and query extracted evidence
from a single database and a focus on emergency medicine, which
cannot elucidate all the features of the metaverse. Most studies are
pilot studies or randomized controlled studies that need more evi-
dence. While many studies shared some commonalities, most were
still unique in their own ways, making them challenging to compare.
The four types of extracted classifications may overlap in some de-
tails and concepts. Publication bias may be present because of the
recording and sharing of administrative applications that are diffi-
cult to digitize.
Conclusion
Metaverse in emergency medicine creates a variety of opportu-
nities by fostering near real-time experience in emergency medicine
by providing highly immersive experiences in clinical training and
education, prehospital and disaster medicine, diagnosis and treat-
ment application, and administrative affairs. AR and VR are the main
application technologies in the metaverse and are used the most in
the education field. VR-related studies surpass AR-related studies in
emergency medicine, but AR holds greater potential in the classifi-
cation of diagnosis and treatment application. Lifelogging and mirror
world have fewer applications but will stimulate emergency medi-
cine once the techniques are developed. Lifelogging will provide
more personal information to health providers, and the mirror world
promises to be a powerful tool for training in disaster medicine re-
sponse.
Metaverse brings a new world and various opportunities, but
limitations and stumbling blocks exist. This scoping review will
provide the emergency care systems with adequate preparedness to
face future challenges. Health providers should ensure the ethical
use of personal information and pay attention to data privacy pro-
tection, security, and governance. A thorough examination of the
ethical aspects and applications of metaverse will prove beneficial
for future responsible development of this field.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Author contributions
TCW drafted the manuscript. TCW, CTBH revised it critically for
important intellectual content. All authors read and approved the
final manuscript.
Competing interests
The authors declare that they have no competing interests.
Acknowledgments
Not applicable.
References
[1] Nikolaidis I. Networking the metaverses. IEEE Netw 2007;21(5):2–+.
[2] Owens D, Mitchell A, Khazanchi D, Zigurs I. An empirical investigation of virtual
world projects and metaverse technology capabilities. Data Base Adv Inf Syst
2011;42(1):74–101.
[3] de Kerckhove D. The personal digital twin, ethical considerations. Philos Trans A
Math Phys Eng Sci 2021;379(2207):20200367.
[4] Smart JCJ, Paffendorf J. Me Metaverse roadmap: pathway to the 3D web; 2007.
〈https://www.metaverseroadmap.org/MetaverseRoadmapOverview.pdf〉.
[5] Milgram P, Takemura H, Utsumi A, Kishino F. Augmented reality: a class of dis-
plays on the reality-virtuality continuum. SPIE; 1995, pp. 282–92.
[6] Kye B, Han N, Kim E, Park Y, Jo S. Educational applications of metaverse: pos-
sibilities and limitations. J Educ Eval Health Prof 2021;18:32.
[7] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA
extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann
Intern Med 2018;169(7):467–73.
[8] Rochlen LR, Levine R, Tait AR. First-person point-of-view-augmented reality for
central line insertion training: a usability and feasibility study. Simul Health
2017;12(1):57–62.
[9] Blum T, Heining SM, Kutter O, Navab N (Eds.). Advanced training methods using
an augmented reality ultrasound simulator. In: Proceedings of the 8th IEEE in-
ternational symposium on mixed and augmented reality; 2009.
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
7
[10] Balian S, McGovern SK, Abella BS, Blewer AL, Leary M. Feasibility of an aug-
mented reality cardiopulmonary resuscitation training system for health care
providers. Heliyon 2019;5(8):e02205.
[11] Leary M, McGovern SK, Balian S, Abella BS, Blewer AL. A pilot study of CPR
quality comparing an augmented reality application vs. a standard audio-visual
feedback manikin. Front Digit Health 2020;2:1.
[12] Toto RL, Vorel ES, Tay KE, Good GL, Berdinka JM, Peled A, et al. Augmented reality
in pediatric septic shock simulation: randomized controlled feasibility trial. JMIR
Med Educ 2021;7(4):e29899.
[13] Yau YW, Li Z, Chua MT, Kuan WS, Chan GWH. Virtual reality mobile application
to improve videoscopic airway training: a randomised trial. Ann Acad Med
Singap 2021;50(2):141–8.
[14] Binstadt E, Donner S, Nelson J, Flottemesch T, Hegarty C. Simulator training
improves fiber-optic intubation proficiency among emergency medicine re-
sidents. Acad Emerg Med 2008;15(11):1211–4.
[15] Hu KC, Salcedo D, Kang YN, Lin CW, Hsu CW, Cheng CY, et al. Impact of virtual
reality anatomy training on ultrasound competency development: a randomized
controlled trial. PLoS One 2020;15(11):e0242731.
[16] Lee DK, Im CW, Jo YH, Chang T, Song JL, Luu C, et al. Comparison of extended
reality and conventional methods of basic life support training: protocol for a
multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial).
Trials 2021;22(1):946.
[17] Buckler DG, Almodovar A, Snobelen P, Abella BS, Blewer A, Leary M. Observing
the stages of bystander intervention in virtual reality simulation. World J Emerg
Med 2019;10(3):145–51.
[18] Leary M, McGovern SK, Chaudhary Z, Patel J, Abella BS, Blewer AL. Comparing
bystander response to a sudden cardiac arrest using a virtual reality CPR training
mobile app versus a standard CPR training mobile app. Resuscitation
2019;139:167–73.
[19] Mallik R, Patel M, Atkinson B, Kar P. Exploring the role of virtual reality to
support clinical diabetes training-a pilot study. J Diabetes Sci Technol 2021.
19322968211027847.
[20] Abulfaraj MM, Jeffers JM, Tackett S, Chang T. Virtual reality vs. high-fidelity
mannequin-based simulation: a pilot randomized trial evaluating learner per-
formance. Cureus 2021;13(8):e17091.
[21] Birrenbach T, Zbinden J, Papagiannakis G, Exadaktylos AK, Müller M, Hautz WE,
et al. Effectiveness and utility of virtual reality simulation as an educational tool
for safe performance of COVID-19 diagnostics: prospective, randomized pilot
trial. JMIR Serious Games 2021;9(4):e29586.
[22] Schmucker M, Haag M. Automated size recognition in pediatric emergencies
using machine learning and augmented reality: within-group comparative
study. JMIR Form Res 2021;5(9):e28345.
[23] Salisbury JP, Keshav NU, Sossong AD, Sahin NT. Concussion assessment with
smartglasses: validation study of balance measurement toward a lightweight,
multimodal, field-ready platform. JMIR Mhealth Uhealth 2018;6(1):e15.
[24] Hilt AD, Mamaqi Kapllani K, Hierck BP, Kemp AC, Albayrak A, Melles M, et al.
Perspectives of patients and professionals on information and education after
myocardial infarction with insight for mixed reality implementation: cross-
sectional interview study. JMIR Hum Factors 2020;7(2):e17147.
[25] Freedman SA, Eitan R, Weiniger CF. Interrupting traumatic memories in the
emergency department: a randomized controlled pilot study. Eur J
Psychotraumatol 2020;11(1):1750170.
[26] Houze-Cerfon CH, Vaissié C, Gout L, Bastiani B, Charpentier S, Lauque D.
Development and evaluation of a virtual research environment to improve
quality of care in overcrowded emergency departments: observational study.
JMIR Serious Games 2019;7(3):e13993.
[27] Xi N, Chen J, Gama F, et al. The challenges of entering the metaverse: an ex-
periment on the effect of extended reality on workload. Inf Syst Front 2022.
[28] Quqandi E, Joy M, Drumm I, Rushton M. Augmented reality in supporting health-
care and nursing independent learning: narrative review. Comput Inf Nurs 2022.
[29] Barsom EZ, Graafland M, Schijven MP. Systematic review on the effectiveness of
augmented reality applications in medical training. Surg Endosc
2016;30(10):4174–83.
[30] Lee JS. Implementation and evaluation of a virtual reality simulation: in-
travenous injection training system. Int J Environ Res Public Health 2022;19(9).
[31] McGrath JL, Taekman JM, Dev P, Danforth DR, Mohan D, Kman N, et al. Using
virtual reality simulation environments to assess competence for emergency
medicine learners. Acad Emerg Med 2018;25(2):186–95.
[33] (a) Khukalenko IS, Kaplan-Rakowski R, An Y, Iushina VD. Teachers' perceptions
of using virtual reality technology in classrooms: a large-scale survey. Educ Inf
Technol 2022:1–23;
(b) Follmann A, Ohligs M, Hochhausen N, Beckers SK, Rossaint R, Czaplik M.
Technical support by smart glasses during a mass casualty incident: a rando-
mized controlled simulation trial on technically assisted triage and telemedical
app use in disaster medicine. J Med Internet Res 2019;21(1):e11939.
[34] Follmann A, Ruhl A, Gösch M, Felzen M, Rossaint R, Czaplik M. Augmented
reality for guideline presentation in medicine: randomized crossover simulation
trial for technically assisted decision-making. JMIR Mhealth Uhealth
2021;9(10):e17472.
[35] Carenzo L, Barra FL, Ingrassia PL, Colombo D, Costa A, Della Corte F. Disaster
medicine through Google Glass. Eur J Emerg Med 2015;22(3):222–5.
[36] Duan YY, Zhang JY, Xie M, Feng XB, Xu S, Ye ZW. Application of virtual reality
technology in disaster medicine. Curr Med Sci 2019;39(5):690–4.
[37] Tin D, Hertelendy AJ, Ciottone GR. Disaster medicine training: the case for virtual
reality. Am J Emerg Med 2021;48:370–1.
[38] Gout L, Hart A, Houze-Cerfon CH, Sarin R, Ciottone GR, Bounes V. Creating a
novel disaster medicine virtual reality training environment. Prehosp Disaster
Med 2020;35(2):225–8.
[39] Luigi Ingrassia P, Ragazzoni L, Carenzo L, Colombo D, Ripoll Gallardo A, Della,
et al. Virtual reality and live simulation: a comparison between two simulation
tools for assessing mass casualty triage skills. Eur J Emerg Med
2015;22(2):121–7.
[40] Ferrandini Price M, Escribano Tortosa D, Nieto Fernandez-Pacheco A, Perez
Alonso N, Cerón Madrigal JJ, Melendreras-Ruiz R, et al. Comparative study of a
simulated incident with multiple victims and immersive virtual reality. Nurse
Educ Today 2018;71:48–53.
[41] Lowe J, Peng C, Winstead-Derlega C, Curtis H. 360 virtual reality pediatric mass
casualty incident: a cross sectional observational study of triage and out-of-
hospital intervention accuracy at a national conference. J Am Coll Emerg
Physicians Open 2020;1(5):974–80.
[42] Beom JH, Kim MJ, You JS, Lee HS, Kim JH, Park YS, et al. Evaluation of the quality
of cardiopulmonary resuscitation according to vehicle driving pattern, using a
virtual reality ambulance driving system: a prospective, cross-over, randomised
study. BMJ Open 2018;8(9):e023784.
[43] Colloca L, Raghuraman N, Wang Y, Akintola T, Brawn-Cinani B, Colloca G, et al.
Virtual reality: physiological and behavioral mechanisms to increase individual
pain tolerance limits. Pain 2020;161(9):2010–21.
[44] Benyoucef Y, Lesport P, Chassagneux A. The emergent role of virtual reality in
the treatment of neuropsychiatric disease. Front Neurosci 2017;11:491.
[45] Dumoulin S, Bouchard S, Ellis J, Lavoie KL, Vézina MP, Charbonneau P, et al. A
randomized controlled trial on the use of virtual reality for needle-related
procedures in children and adolescents in the emergency department. Games
Health J 2019;8(4):285–93.
[46] Chan E, Hovenden M, Ramage E, Ling N, Pham JH, Rahim A, et al. Virtual reality
for pediatric needle procedural pain: two randomized clinical trials. J Pediatr
2019;209:160–7. e4.
[47] Schlechter AK, Whitaker W, Iyer S, Gabriele G, Wilkinson M. Virtual reality
distraction during pediatric intravenous line placement in the emergency de-
partment: a prospective randomized comparison study. Am J Emerg Med
2021;44:296–9.
[48] Osmanlliu E, Trottier ED, Bailey B, Lagacé M, Certain M, Khadra C, et al.
Distraction in the Emergency department using Virtual reality for INtravenous
procedures in Children to Improve comfort (DEVINCI): a pilot pragmatic ran-
domized controlled trial. CJEM 2021;23(1):94–102.
[49] Butt M, Kabariti S, Likourezos A, Drapkin J, Hossain R, Brazg J, et al. Take-pause:
efficacy of mindfulness-based virtual reality as an intervention in the pediatric
emergency department. Acad Emerg Med 2021.
[50] Aardoom JJ, Hilt AD, Woudenberg T, Chavannes NH, Atsma DE. A preoperative
virtual reality app for patients scheduled for cardiac catheterization: pre-post
questionnaire study examining feasibility, usability, and acceptability. JMIR
Cardio 2022;6(1):e29473.
[51] Ovunc SS, Yolcu MB, Emre S, Elicevik M, Celayir S. Using immersive technologies
to develop medical education materials. Cureus 2021;13(1):e12647.
[52] Petrica A, Lungeanu D, Ciuta A, Marza AM, Botea MO, Mederle OA. Using 360-
degree video for teaching emergency medicine during and beyond the COVID-19
pandemic. Ann Med 2021;53(1):1520–30.
[53] Dodge M, Kitchin R. ‘Outlines of a world coming into existence’: pervasive
computing and the ethics of forgetting. Environ Plan B Plan Des
2007;34(3):431–45.
[54] Sila-Nowicka K, Thakuriah P. Multi-sensor movement analysis for transport
safety and health applications. PLOS ONE 2019;14(1):e0210090.
[55] Kim JW, Ryu B, Cho S, Heo E, Kim Y, Lee J, et al. Impact of personal health records
and wearables on health outcomes and patient response: three-arm randomized
controlled trial. JMIR Mhealth Uhealth 2019;7(1):e12070.
[56] Kumari P, Mathew L, Syal P. Increasing trend of wearables and multimodal in-
terface for human activity monitoring: A review. Biosens Bioelectron
2017;90:298–307.
[57] Jung SY, Kim JW, Hwang H, Lee K, Baek RM, Lee HY, et al. Development of
comprehensive personal health records integrating patient-generated health
data directly from Samsung S-health and Apple health apps: retrospective cross-
sectional observational study. JMIR Mhealth Uhealth 2019;7(5):e12691.
[58] Munzer BW, Khan MM, Shipman B, Mahajan P. Augmented reality in emergency
medicine: a scoping review. J Med Internet Res 2019;21(4):e12368https://doi.
org/10.2196/12368. PMID: 30994463; PMCID: PMC6492064.
[59] Behmadi S, Asadi F, Okhovati M, Ershad Sarabi R. Virtual reality-based medical
education versus lecture-based method in teaching start triage lessons in
emergency medical students: virtual reality in medical education. J Adv Med
Educ Prof 2022;10(1):48–53.
[60] Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced
technology in medical education. Acad Emerg Med 2004;11(11):1149–54.
[61] Wilkerson W, Avstreih D, Gruppen L, Beier KP, Woolliscroft J. Using immersive
simulation for training first responders for mass casualty incidents. Acad Emerg
Med 2008;15(11):1152–9.
[62] Broach J, Hart A, Griswold M, Lai J, Boyer EW, Skolnik AB, et al. Usability and
reliability of smart glasses for secondary triage during mass casualty incidents.
In: Proceedings of the annual Hawaii international conference on system sci-
ences; 2018. pp. 1416–22.
[63] Li N, Sun N, Cao C, Hou S, Gong Y. Review on visualization technology in si-
mulation training system for major natural disasters. Nat Hazards 2022:
1–32.
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
8
[64] Sikka N, Shu L, Ritchie B, Amdur RL, Pourmand A. Virtual reality-assisted pain,
anxiety, and anger management in the emergency department. Telemed J E
Health 2019;25(12):1207–15.
[65] Gelonch O, Ribera M, Codern-Bové N, Ramos S, Quintana M, Chico G, et al.
Acceptability of a lifelogging wearable camera in older adults with mild cogni-
tive impairment: a mixed-method study. BMC Geriatr 2019;19(1):110.
[66] Choi J, Choi C, Ko H, Kim P. Intelligent healthcare service using health lifelog
analysis. J Med Syst 2016;40(8):188.
[67] Ksibi A, Alluhaidan A, Salhi A, El-Rahman S. Overview of lifelogging: current
challenges and advances. IEEE Access; 2021. p. 1.
T.-C. Wu and C.-T.B. Ho Australasian Emergency Care xxx (xxxx) xxx–xxx
9
