Self-efficacy in mass casualty incident training using mixed reality

Throughout Europe, Emergency Medical Services (EMS) rely heavily on Medical First Responders (MFR) to ensure early stabilization and appropriate handling of complex Mass Casualty Incidents (MCI). Mixed Reality (MR), also known as Augmented Reality (AR), provides interactive training by integrating real environments with digital components. This technology enables MFR to practise complex decision-making and hands-on interventions in high-stress, simulated scenarios. However, assessing its genuine effectiveness remains challenging, as true competency is often difficult to demonstrate outside real-life emergencies. This study aims to measure pre- and post-test changes in perceived self-efficacy among MFR following a targeted MR intervention focused specifically on the initial management of MCI.

A pre-test/post-test survey design was employed with 274 MFR who underwent detailed MR training simulating complex, early-stage MCI scenarios. To analyze the intervention's precise impact on participant confidence, data were analyzed using both within- and between-subjects ANOVA, providing information about the change in self-efficacy across the cohort.

The analysis revealed a statistically significant increase in perceived self-efficacy among the 274 participants following the training (F(1,270)=169.36, p<.01, η²=.385). The mean score increased from 34.45 (SD=6.27) to 38.38 (SD=5.40), representing an absolute increase of 3.93 points. This corresponds to an 11.41% increase relative to baseline scores and an 8.19% increase when calculated against the maximum possible score (48 points), indicating a strong practical effect of the intervention. The MR intervention could detect change and indicate a positive influence on confidence and how a combined approach including MR training can improve MFR perceived preparedness.

Findings suggest that MR training significantly enhances MFRs' perceived self-efficacy in managing MCIs. Consequently, integrating immersive MR technologies into emergency training programs may represent a valuable complementary strategy for strengthening organizational disaster preparedness and improving MFR confidence and decision-making skills in high-stakes situations.