habits of vitality 24
Chuan Hao (Alex) Chen is an MD-PhD candidate in anthropology at the University of Pennsylvania. He holds a Bachelor of Architecture from Cornell and a Masters of Design from the Harvard Graduate School of Design. His research engages the intersection of culture, health, and design, using ethnographic and design methods to elucidate and speculate upon the cultural construction of healthcare spaces and infrastructure.
I
recently volunteered for an experiment at the University of Pennsylvania School of Nursing that involved virtual reality (VR) and emergency response. The research assistant, who hunted all over the library for study participants, explained that they wanted to simulate an event and observe how people would act. She made me put on some heavy black goggles and I found myself standing on the sidewalk of a crudely drawn 3D city. I watched passersby wander around the streets aimlessly, sometimes walking straight into me and disappearing from sight. A few seconds later, a man came into my view from the left. As soon as he walked in front of me, he collapsed.
Public Health, Medicine, Design
Before putting on the VR goggles, I had guessed (because this was a nursing school study) that the simulated scenarios would be medical: perhaps involving someone getting injured or someone collapsing and becoming unresponsive. These are the typical scenarios in basic life support (BLS) training taught to healthcare providers like nurses and doctors, but especially emergency medical technicians (EMTs). As I signed the research consent form, I frantically tried to recall the BLS skills that I had learned during my EMT training, scared that I would not remember what to do in case I do encounter a medical emergency in real life. I learned BLS because knowing how to save a life seems important, especially when the chances of someone choking or having a heart attack in a contemporary city is very real and there are concrete interventions. As soon as the man collapsed, I fell into BLS mode and started the steps for cardiopulmonary resuscitation (CPR), a part of the BLS protocol. I crouched down on the floor to check for his response. “Sir, sir, are you alright? Are you okay?” Given that this was a visual simulation, I was surprised to feel a three-dimensional head and torso where I saw the downed man on the screen. I first checked for a pulse by touching his neck, then I crouched down to see if his chest rose and fell with each breath. Being a mannequin, the man had neither signs of life. I shouted at one of the wandering bystanders to get help, and to my surprise he responded by pulling out his phone. I started doing chest compressions, pushing in order to help his stilled heart pump blood. The familiar sensation of silicon skin triggered my memory: “One, two, three, four…” I counted out the compressions, screaming into what I knew was an empty seminar room in the library. After 20 pushes, I tilted his head back to deliver two breaths via mouth-to-mouth resuscitation. Perhaps recognizing my hesitation at putting my mouth on a mannequin without a protective mask, the research assistant spoke, “It’s okay, just go through the motions, you don’t have to actually do it.” I hovered my mouth over the patient’s mouth and blew. I then returned to chest compressions, and the research assistant stopped me after three more rounds of CPR. The purpose of the study was to see how many people know how to act in a medical emergency. While we can always call 911, every second counts in these scenarios. Having someone close by who can start CPR before the professionals arrive increases the patient’s chance of survival. They also wanted to see how VR technology could help people learn and practice for such scenarios. From a systems perspective, this problem seems technical. The task is to figure out how to put people with the right skills in the right space at the right time. But it’s hard to account for the impact of emotions—of fear and exhilaration—when you literally hold another’s life in your hands. I felt the sweat bead up around my forehead and my heart sink into my stomach in a rush of adrenaline as soon as I saw the man collapse in front of me. These fight or flight symptoms are not just for the patient whose life is hanging in the balance: they are experienced by both everyday and professional rescuers. Because these physical symptoms and emotions make it difficult for rescuers, especially novices, to focus on their task, training programs stress the importance of muscle memory. In an emergency situation, there is no time to think or to process