By Dr. Gale M. Lucas, Director, Technology Evaluation Lab, ICT; Research Associate Professor, USC Viterbi School of Engineering
In this essay, Dr. Gale M. Lucas discusses the academic paper, Impact of behavior-based virtual training on active shooter incident preparedness in healthcare facilities (Ruying Liu, Burcin Becerik-Gerber, Gale M. Lucas, Kelly Busta), which has just been published in the International Journal of Disaster Risk Reduction.
Disasters strike without warning. In the healthcare sector, where the primary mission is to save lives, the challenge is twofold—caregivers must not only protect themselves but also ensure the safety of patients who may be physically or cognitively impaired. Traditional emergency preparedness methods, including passive training sessions and drills, have long been the standard.
However, our recent research – Impact of behavior-based virtual training on active shooter incident preparedness in healthcare facilities (Ruying Liu, Burcin Becerik-Gerber, Gale M. Lucas, Kelly Busta) – demonstrates that Virtual Reality (VR)-based training presents a more effective and engaging alternative, particularly in the case of active shooter incidents (ASIs).
The Growing Threat of Active Shooter Incidents in Healthcare
Healthcare facilities face unique risks in the event of an active shooter incident. Unlike offices or schools, hospitals contain patients who may not be able to evacuate independently, as well as complex layouts that hinder quick escape routes. These challenges necessitate specialized training that prepares healthcare workers for the nuances of their environment.
Specifically, employees in healthcare settings face ethical dilemmas that force them to decide between personal safety and duty of care. The “run, hide, fight” protocol, the gold standard in active shooter preparedness, is not a one-size-fits-all solution when it comes to healthcare facilities. In hospitals, healthcare providers could choose to hide with their patients rather than flee, even when escape is possible. This requires a more sophisticated approach to training—one that not only teaches survival tactics but also builds resilience in high-pressure situations.
Why VR-Based Training Works
Immersive VR training offers an unparalleled level of realism. In our research, we developed a VR training platform specifically tailored to healthcare settings. This platform simulated real hospital layouts, incorporated a behavior-driven storyline, and provided interactive decision-making opportunities, all of which were informed by extensive stakeholder engagement with security professionals and healthcare administrators. Unlike slide-based lectures or video tutorials, our VR training allows participants to experience an unfolding crisis firsthand, and the way the active shooter incident unfolds is driven by that decisions that they make.
One of the most valuable aspects of VR training is its ability to replicate stress-inducing scenarios in a safe environment. Trainees must decide whether to run, hide, or fight while encountering realistic obstacles—patients unable to evacuate, locked doors, and the chaotic movements of unprepared colleagues. The training’s interactive feedback system helps users understand the consequences of their decisions without real-world risks.
Evidence for Effectiveness
To assess the effectiveness of this VR-based training, we conducted a study with 97 workers in a hospital, comparing the VR-based training to a control group. The results were striking. Participants who engaged in the VR simulation demonstrated improved response times, more effective decision-making under pressure, and a greater sense of preparedness.
Additionally, the study revealed fascinating insights into how personal factors influence training outcomes. For example, female participants showed the most significant improvement in response performance, possibly due to initial differences in self-perception of their navigation abilities. Patient-care workers, who are less accustomed to using mobile phones in emergencies, greatly benefited from the fact that the training reinforced emergency communication strategies.
Beyond individual preparedness, VR training also fosters a culture of collective resilience. Trainees were more likely to assist others during an emergency scenario, recognizing that survival often depends on coordinated efforts.
Looking to the Future
As VR technology becomes more accessible, its potential to revolutionize disaster preparedness in healthcare grows. Future research could explore adaptive training systems that personalize scenarios based on an individual’s strengths and weaknesses. Machine learning could be integrated to tailor experiences dynamically, ensuring that each participant receives the most effective training for their specific role and skill level.
Ultimately, our study highlights that VR is not just a technological novelty—it is a vital tool for equipping healthcare professionals with the skills and confidence they need to protect themselves and their patients in life-threatening situations. The stakes are too high for anything less.
By embracing VR-based training, we take a critical step forward in building a healthcare workforce that is not only skilled in patient care but also resilient in the face of crises. The future of disaster preparedness is here, and it is immersive, interactive, and effective.
This work was supported by the U.S. Department of Homeland Security [Grant No. EMW-2021-GR-00119] and the Army Research Office [Cooperative Agreement Number W911NF-20-2-0053]. The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the U.S. Department of Homeland Security, Army Research Office, or the U.S. Government. We would also like to thank Lieutenant Ralph R. Roseli, who is also a graduate of the FBI National Academy, for providing insightful comments throughout the creation of the training platform.
AUTHOR BIO
Dr. Lucas holds a BA in Psychology from Willamette University, a PhD in Psychology from Northwestern University, and did her postdoctoral study in Human-Computer Interaction at the University of Southern California (USC). She joined ICT in 2013 as a Postdoc in the Affective Computing Lab, became a Research Assistant Professor of Computer Science and Civil and Environmental Engineering at USC Viterbi School of Engineering in July 2018, and then was promoted to Research Associate Professor in July 2024.
As Director of ICT’s Technology Evaluation Lab, Dr. Lucas conducts lines of research in Human-Computer Interaction (HCI), Human-Robot Interaction (HRI) and Human-Building Interaction (HBI) with the goal to optimize interaction, and subsequent outcomes, between humans and social intelligence, including virtual agents, social robots, and other social interfaces in the built environment.
Alongside her role as Research Associate Professor, VSOE and Director, Technology Evaluation Lab, ICT, Dr. Lucas continues to serve as Co-Director of CENTIENTS, Center for Intelligent Environments, a cross-disciplinary partnership with the Sonny Astani Department of Civil and Environmental Engineering at the University of Southern California.
//