We are working with colleagues in Medicine, Health Sciences, and staff at the Southampton General Hospital Emergency Department to capture a Major Trauma Resuscitation Simulation in 360 degree video. When viewed in a virtual reality headset, the audience is at the centre of the action. This pilot project aims to provide ground-breaking learning resources for students allowing them to experience complex and infrequent events as realistically as possible, whilst being supported with face to face teaching. Keep reading to learn more about some of the challenges in carrying out this kind of filming.
- Michael Kiuber, Consultant in Emergency Medicine & Foundation Programme Director
- Eloise Monger, Programme Lead MSc/PGDip Nursing
- Jack Bradley, Foundation Year Doctor
- Sarah Fielding, Professional Specialist in Learning Design, Digital Learning Team
- Paul Blatch, Multimedia Developer, Digital Learning Team
Pre-production: planning and objectives
Emergency Care staff regularly participate in Trauma Simulations at Southampton General Hospital. However, students are not always present. When genuine trauma cases enter Resus, any students in attendance have to observe at a distance. Our main objectives for the first round of filming were to:
- explore the challenges of filming in 360 in an unobtrusive way
- obtain usable and meaningful footage that could be evaluated with students.
- create a pilot video that will be a blueprint for future filming and refinement.
The EM Consultant on the project team arranged for us to attend a scheduled trauma sim. The simulation for that day was based on a young (mid-twenties) male patient involved in a motorbike accident. The patient was a volunteer. The EM Consultant used a tablet computer to stream patient stats such as heart rate and blood oxygen levels to equipment used by the team in the Resus bay.
The EM Consultant briefed the trauma team about the presence and purpose of the Digital Learning Team, but not the nature of the simulation; their reactions would be genuine.
This was possibly one of the most challenging and adrenaline driven shoots for the Digital Learning Team. The stakes were very high, as our presence on the day was a secondary purpose. The primary purpose is to provide the Trauma team with opportunity to hone essential skills as part of a team. It was very important that we did not cause disruption to the team.
High stakes, single take
The simulation preparation, action, and debrief can take about an hour to carry out and takes place in a working Accident and Emergency Department. There is no time to re-run a simulation on the same day; and the activity itself can be cancelled at any moment if genuine cases arrive. The Digital Learning Team had to capture the simulation in a single take so there was no room for error.
Right in the action
We needed to be as close as possible to the action, without causing obstruction. To do this we opted for our Go Pro Fusion 360 camera on a light stand. The Ambulance trolley and patient would be wheeled into Resus, where a team of over 6 people would transfer the patient to the Resus bed. For this reason, the tripod had to have a small footprint so as not to present a trip hazard for staff. Coupled with a minimum height of 165 cm for the camera, the stand was in danger of tipping over if bumped by staff during the simulation.
The camera had to be placed in a natural position of a person within the team. Trauma Teams are highly skilled and each person has a specific role to play in a small space, so there was some discussion about where best to place the camera. In the end we opted for the foot of the bed, next to the team Lead, and just in front of where the scribe would normally stand. In this video, the viewer stands on the opposite side to where the nursing staff were administering blood products.
Audio and image quality
The slight distortion effect of stitching is minimised by having only two lenses on the camera. However, it is important that people in the video do not stand on the ‘stitch line’; the distortion is more noticeable with moving subjects. We used a small amount of masking tape on the floor to record the position of the tripod (in case it moved) and denote the stitch line for the trauma team.
There was not sufficient time to mic up individuals before the start of the simulation; so we opted to tape a tascam mic to the tripod, just beneath the camera. The camera records directional audio, but the Tascam ensures that key members of the Trauma team can be heard clearly. Planning future options might include disguising sound equipment in the scene itself.
Paul, our project team Media Developer, has been working on several post-production elements. The entire take was approximately 20 minutes long. After neatly trimming the start and finish, this still leaves technically complex medical content lasting 15 minutes. In consultation with the ED Consultant, Paul incorporated a menu which allows the viewer to navigate between key stages of the simulation. In addition, he embedded ultrasound video (provided by Michael Kiuber) into the video. The team is also investigating embedding knowledge checks in the form of multiple choice questions.
The post-production edits are nearly compete. Staff and students will evaluate the pilot video over the next few months. Following a review of feedback the team will look to schedule filming a second trauma simulation. This will incorporate learner feedback and refine some of the filming processes/choreography required for working with this dynamic medium.