{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T07:01:41Z","timestamp":1789887701937,"version":"4.0.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100014440","name":"Ministry of Science, Innovation and Universities","doi-asserted-by":"publisher","award":["PID2022-138884NA-I00"],"award-info":[{"award-number":["PID2022-138884NA-I00"]}],"id":[{"id":"10.13039\/100014440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014440","name":"Ministry of Science, Innovation and Universities","doi-asserted-by":"publisher","award":["MCIN\/AEI\/10.13039\/501100011033\/FEDER"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033\/FEDER"]}],"id":[{"id":"10.13039\/100014440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mass-casualty incident (MCI) triage is difficult to teach and assess under realistic operational conditions. Immersive virtual reality (VR) may provide a standardized and operationally relevant platform for evaluating triage decision-making and prioritization of immediate life-saving interventions during disaster preparedness exercises.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate performance in MCI triage and prioritization of immediate life-saving interventions using an immersive VR scenario embedded in a NATO civil\u2013military emergency management exercise, while also describing participants\u2019 perceptions of usefulness, ease of use, immersion, and physical comfort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional observational study was conducted during the NATO Emergency Management Exercise \u201cBulgaria 2025\u201d in Montana, Bulgaria. Civilian and military first responders who completed the immersive scenario and post-experience questionnaire were included. The VR assessment, delivered through Meta Quest 3 headsets and haptic vests, comprised 14 triage items and 2 immediate life-saving intervention items. The reference standard for triage categorization was based on the Simple Triage and Rapid Treatment (START) algorithm. The primary outcome was item-level accuracy. Secondary outcomes included perceived usefulness, ease of use, immersion, physical comfort, and perceived contribution of haptic feedback.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 102 valid post-simulation questionnaires were analyzed. Participants had a mean age of 34.3 years (SD 8.8), were predominantly male (98.0%), mainly military-affiliated (86.3%), and had a median of 10 years of professional experience. Triage performance was heterogeneous: accuracy exceeded 75% in several core items. Perceived usefulness and ease of use were high, with composite medians of 7.0 (IQR 6.0-7.0) and 7.0 (IQR 6.5-7.0), respectively. Presence\/immersion was also high (median 6.25, IQR 5.5-7.0), and discomfort was low (median 1.0, IQR 1.0-2.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a NATO civil\u2013military emergency management exercise, immersive VR was highly acceptable, usable, and well tolerated, while revealing substantial item-level variability in MCI triage decisions and immediate life-saving intervention choices. These findings suggest that immersive VR may offer a feasible and operationally relevant platform for standardized assessment of disaster triage performance and for identifying specific decision bottlenecks relevant to preparedness and interoperability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag415","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:36:05Z","timestamp":1787657765000},"source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of Immersive Virtual Reality for Assessing Mass-Casualty Triage Decision-Making in a NATO Civil\u2013Military Emergency Management Exercise: A Cross-Sectional Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7990-8497","authenticated-orcid":false,"given":"Lucia","family":"L\u00f3pez Ferr\u00e1ndiz","sequence":"first","affiliation":[{"name":"Grupo de Investigaci\u00f3n de Nuevas Tecnolog\u00edas para la Salud, UCAM Universidad Cat\u00f3lica de 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