{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:36:54Z","timestamp":1789925814309,"version":"4.0.1"},"reference-count":34,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014440","name":"Ministry of Science, Innovation and Universities","doi-asserted-by":"crossref","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":"crossref"}]},{"DOI":"10.13039\/100014440","name":"Ministry of Science, Innovation and Universities","doi-asserted-by":"crossref","award":["PID2022-138884NA-I00"],"award-info":[{"award-number":["PID2022-138884NA-I00"]}],"id":[{"id":"10.13039\/100014440","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,10]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the feasibility and acceptability of an immersive virtual reality (VR) scenario for assessing decision-making in accidental hypothermia resuscitation within a civil\u2013military disaster-management exercise, and to explore neurophysiological signals as hypothesis-generating correlates of decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A multinational civil\u2013military disaster-management exercise in Bulgaria (September 2025).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Convenience sample of first responders who completed the VR scenario and post-experience questionnaire (n=62; mean age 30.6 years (SD 7.8); 59\/62 male (95.2%) and 3\/62 female (4.8%); 43\/62 civilian (69.4%) and 19\/62 military (30.6%)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants completed an interactive 360\u00b0 immersive VR scenario with multiple-choice decision points covering key steps in accidental hypothermia management. A subsample underwent exploratory neurophysiological monitoring (electroencephalogram (EEG)\/ECG) during the scenario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome was decision accuracy across scenario decision points. Secondary outcomes included perceived usefulness, ease of use, presence and physical discomfort. Exploratory outcomes (subsample) included EEG-derived engagement index and frontal alpha asymmetry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-two participants completed the simulation. Perceived usefulness and ease of use reached the highest median score (7.0 (IQR 6\u20137.0)), with &gt;95% agreement across items. Decision accuracy across decision points ranged from 37.5% to 85.7%, with lower accuracy in hypothermia-specific algorithm steps compared with general resuscitation actions. In a very small exploratory EEG\/ECG subsample, illustrative case-level, event-locked individual traces suggested possible differences preceding incorrect responses (hypothesis-generating only).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Immersive VR was feasible and well accepted for assessing hypothermia resuscitation decision-making in a civil\u2013military exercise. Observed performance highlighted hypothermia-specific decision gaps. Controlled and longitudinal studies are needed to evaluate learning gain and training effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113246","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:56:16Z","timestamp":1774932976000},"page":"e113246","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Can immersive virtual reality assess hypothermia resuscitation decision-making? A cross-sectional study in a civil\u2013military disaster management context"],"prefix":"10.1136","volume":"16","author":[{"given":"Carmen Amalia","family":"Lopez Lopez","sequence":"first","affiliation":[{"name":"Nursing Faculty, UCAM Universidad Cat\u00f3lica de Murcia, Murcia, Spain"},{"name":"Gerencia de Urgencias y Emergencias Sanitarias 061 de la Regi\u00f3n de Murcia (Espa\u00f1a), Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Greif","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Bern, Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Semeraro","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Belen","family":"Ocampo Cervantes","sequence":"additional","affiliation":[{"name":"Nursing Faculty, UCAM Universidad Cat\u00f3lica de Murcia, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Pons Claramonte","sequence":"additional","affiliation":[{"name":"Universidad Catolica de Murcia Facultad de Ciencias de la Salud, Murcia, Region of Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Nieto Caballero","sequence":"additional","affiliation":[{"name":"Gerencia de Urgencias y Emergencias Sanitarias 061 de la Regi\u00f3n de Murcia (Espa\u00f1a), Murcia, Spain"},{"name":"Universidad Catolica de Murcia Facultad de Ciencias de la Salud, Murcia, Region of Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7965-0134","authenticated-orcid":false,"given":"Manuel","family":"Pardo R\u00edos","sequence":"additional","affiliation":[{"name":"Nursing Faculty, UCAM Universidad Cat\u00f3lica de Murcia, Murcia, Spain"},{"name":"Gerencia de Urgencias y Emergencias Sanitarias 061 de la Regi\u00f3n de Murcia (Espa\u00f1a), Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4968-1364","authenticated-orcid":false,"given":"Daniel Mart\u00ednez","family":"Guillen Martinez","sequence":"additional","affiliation":[{"name":"Nursing Faculty, UCAM Universidad Cat\u00f3lica de Murcia, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"S\u00e1nchez G\u00f3mez","sequence":"additional","affiliation":[{"name":"Gerencia de Urgencias y Emergencias Sanitarias 061 de la Regi\u00f3n de Murcia (Espa\u00f1a), Murcia, Spain"},{"name":"Universidad Catolica de Murcia Facultad de Ciencias de la Salud, Murcia, Region of Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin Plamenov","family":"Georgiev","sequence":"additional","affiliation":[{"name":"National Association of Volunteers in the Republic of Bulgaria, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin Lyubomirov","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Euro-AtlanticDisaster Response Coordination Centre, NATO HQ, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Lopez Ferrandiz","sequence":"additional","affiliation":[{"name":"Nursing Faculty, UCAM Universidad Cat\u00f3lica de Murcia, Murcia, Spain"},{"name":"Gerencia de Urgencias y Emergencias Sanitarias 061 de la Regi\u00f3n de Murcia (Espa\u00f1a), Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"2026033021552730000_16.3.e113246.1","unstructured":"North Atlantic Treaty Organization . 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