The impact of Augmented Reality in improving the efficiency of

Medical Emergency First Responders in dealing with Emergencies &

Saving Lives

Sameer Ali Khan

2167123

MSPM

IRS-1

Sir Faiz Ahmed

SZABIST Karachi Campus

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Contents

1. Introduction 2
2. Literature Review: 4
3. Research Design & Methods: 6
4. References: 6

The impact of Augmented Reality in improving the efficiency of Medical Emergency First
Responders in dealing with Emergencies & Saving Lives

1. Introduction

Over the past decade, the realms of augmented reality (AR) and virtual reality (VR) have seen a
remarkable upsurge in attention and exploration within the medical domain. This surge in
interest has catalyzed a recent surge in research dedicated to unraveling the potential applications
of AR in the realm of remote healthcare delivery and communication. A multitude of studies
have delved deep into the integration of AR within real-time telemedicine contexts, spanning a
diverse array of medical specialties and operational settings. Particularly noteworthy is the
adoption of AR technology by remote emergency services, where it has been harnessed to fortify
disaster support mechanisms and enhance the efficacy of simulation-based medical education.

Despite the burgeoning presence of AR in the annals of medical literature and its seemingly
transformative potential in the landscape of remote medical services, a conspicuous research
void looms large. Surprisingly, the perspectives of telemedicine providers, the very individuals at
the forefront of modern healthcare delivery, remain largely uncharted territory concerning their
views on this innovative technology. It is in this critical gap that this proposal finds its raison
d'être—an earnest call for further inquiry into this neglected facet of the medical technology

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landscape. This call is underpinned by the recognition of the profound impact that the insights
and perspectives of telemedicine providers could have on the trajectory and future development
of AR within the healthcare arena.

The envisioned study, which forms the crux of this proposal, is poised to serve as a beacon
guiding us through uncharted territory. It endeavors to illuminate the potential applications and
identify the formidable obstacles that lie ahead on the journey of incorporating augmented reality
(AR) into the realm of telemedicine. In doing so, it takes a holistic approach by engaging
emergency medicine providers who exhibit a diverse spectrum of experiences encompassing
telemedicine, AR, and virtual reality (VR) technologies. Through in-depth interviews and
rigorous analysis, this study aspires to unearth the nuanced perspectives and anticipations of
these providers. By delving into their unique vantage points and tapping into their practical
experiences, the study endeavors to paint a comprehensive picture of how AR may be embraced,
challenged, or integrated within the complex fabric of telemedicine.

In essence, this proposal underscores the pressing need to embark on this investigative journey,
emphasizing the pivotal role that telemedicine providers play in shaping the trajectory of AR
within the healthcare ecosystem. Their insights, gleaned from the frontline of healthcare
delivery, hold the potential to inform and reshape the future of AR technology, potentially
revolutionizing the way medical services are rendered and experienced in the years to come.My
research question therefore will be:

Q1: How do emergency providers envision the utilization of AR within the context of
telemedicine?
Q2: What are the foreseen opportunities and obstacles at the convergence of AR and
telemedicine, as anticipated by these providers?
Q3: What are the expected responses of other providers and patients to the integration of AR into
telemedicine, according to emergency providers' perspectives?

2. Literature Review:

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Telemedicine, defined as the utilization of communication and information technology to
enhance access to medical care or information [Teoli D, Aeddula NR. Telemedicine], is often
interchangeably used with terms like telehealth and virtual health. Telemedicine primarily
centers on clinical services, while telehealth encompasses a broader spectrum, encompassing
both clinical and nonclinical remote healthcare services, including those relevant to public health
and healthcare administration purposes [Witkowska-Zimny M, Nieradko-Iwanicka B.
Telemedicine]. Going a step further, virtual health emerges as an even broader concept,
encompassing a plethora of medical innovations and services that eschew face-to-face
interactions. These encompass but are not limited to remote visits, digital communication, real-
time monitoring, and various tools designed to augment patient access to healthcare services
[Hassani K, McElroy T, Coop M, Pellegrin J].

Although telemedicine has been in existence for decades, its utilization by physicians remained
somewhat limited until the outbreak of the COVID-19 pandemic. During this pivotal period,
changes in reimbursement structures and regulatory frameworks expedited the widespread
adoption of real-time audio-video platforms for the provision of medical services [Kane CK,
Gillis K. The use of telemedicine]. As the ripple effects of telemedicine have permeated various
medical specialties [Yao P, Adam M, Clark S, Hsu H, Stern M, Sharma R, et al], and as public
awareness of its convenience has soared, many experts and observers have postulated that
healthcare providers will continue to embrace telemedicine as a viable option for certain services
in the foreseeable future.

Telemedicine has been explored across a wide spectrum of applications, ranging from patient
examinations [Yao P, Adam M, Clark S, Hsu H, Stern M, Sharma R, et al] and teleconsultations
[Carrillo de Albornoz S, Sia KL, Harris A] to cutting-edge domains like telesurgery [Smith SM,
Jacobsen JH, Atlas AP, Khoja A] and medical education [Iancu AM, Kemp MT, Alam HB].
However, despite these promising forays, it is worth noting that a substantial portion of users still
does not view telemedicine as a direct substitute for in-person care. Physicians, for instance,
have cited limitations in diagnostic capabilities [Davoodi NM, Chen K, Zou M, Li M, Jiménez F,
Wetle TF, et al] and concerns regarding adequate training [Moore MA, Coffman M, Jetty A,
Petterson S, Bazemore], while patients have expressed reservations about limited interactivity

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and the challenges of access [Almathami HK, Win KT, Vlahu-Gjorgievska E]. Nevertheless,
optimism persists, driven by ongoing advancements in technology that seek to surmount these
barriers. In this context, augmented reality (AR) has emerged as a technology with significant
transformative potential.

Augmented reality (AR) and virtual reality (VR), two closely related yet distinct branches of
emerging technology within the purview of mixed reality, offer unique possibilities. VR is
characterized by complete immersion, where all user experiences are synthesized entirely within
the virtual realm. In contrast, AR is defined by the amalgamation of the virtual world with the
real world, where computer-generated audio, graphics, or video overlays are seamlessly
integrated into the user's perception of reality [Berryman DR. Augmented reality]. The utilization
of head-mounted devices (HMDs) in VR effectively blocks out the external environment,
replacing it with a computer-generated, immersive environment. On the other hand, AR can be
implemented via various means, including HMDs or software on personal devices, enhancing the
user's real-world experience by superimposing digital elements onto it [Brigham TJ. Reality
check].

Recent research endeavors have showcased AR's integration into real-time telemedicine
contexts, spanning a diverse array of applications such as telerehabilitation [Borresen A, Wolfe
C, Lin CK, Tian Y, Raghuraman S, Nahrstedt K, et al], inpatient consultations [Levy JB, Kong
E, Johnson N, Khetarpal A, Tomlinson J, Martin GF, et al], telepathology [Hanna MG, Ahmed I,
Nine J, Prajapati S, Pantanowitz L], and remote plastic surgery education [Cooper L, Din AH,
Fitzgerald O'Connor E, Roblin P, Rose V, Mughal M]. These developments underscore the
burgeoning potential of AR to reshape and enhance the landscape of telemedicine, offering
innovative solutions that hold the promise of addressing longstanding limitations and challenges
within the field.

The literature review listed above shall help us delve into the challenges and the perception of
such futuristic ideas. Whether these are practical and widely accepted is something I can predict
upon closure.

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3. Research Design & Methods:

The plan is to conduct a study across various academic medical institutions, where the
recruitment of various emergency medicine providers possessing varying degrees of exposure to
telemedicine and augmented reality (AR) or virtual reality (VR) technology will be conducted.
The plan is to employ a snowball sampling approach to select participants for semistructured
interviews. These interviews will be designed to explore the potential applications of AR within
telemedicine, as well as the expected challenges hindering its integration into this domain.
Additionally, I will investigate the perspectives of providers and patients regarding the
introduction of AR technology into telemedicine. During the interviews, I will incorporate video
demonstrations featuring a prototype utilizing AR to ensure that I gather comprehensive and
well-informed insights regarding AR's potential in remote healthcare. Subsequently, the
interviews will be transcribed, and thematic coding will be applied for analysis.

The study will reveal two major areas where AR is envisioned to find utility within telemedicine.
Firstly, it will be perceived as a valuable tool for enhancing information gathering by
augmenting observational tasks, such as visual examinations, and enabling simultaneous access
to data and remote experts. Secondly, AR is anticipated to play a significant role in enhancing
distance learning for both minor and major medical procedures, as well as nonprocedural skills
like cue recognition and empathy, which are crucial for both patients and trainees. Furthermore,
AR has the potential to augment long-distance education programs, thereby providing support to
less specialized medical facilities. However, it is important to note that the introduction of AR
may exacerbate existing financial, structural, and literacy barriers within the realm of
telemedicine.

Providers participating in the study will express their desire for tangible value, which they expect
to be demonstrated through extensive research on clinical outcomes, patient satisfaction, and the
financial benefits associated with AR implementation. They will also highlight the importance of
institutional support and early training before adopting novel tools like AR. Overall, a mixed
reception is anticipated, and the study will underscore the significance of consumer adoption and
awareness as pivotal factors influencing the adoption of AR within the field of telemedicine.

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4. References:

1. Teoli D, Aeddula NR. Telemedicine. In: StatPearls. Treasure Island, FL, USA: StatPearls
Publishing; 2022.
2. Witkowska-Zimny M, Nieradko-Iwanicka B. Telemedicine in emergency medicine in the
COVID-19 pandemic-experiences and prospects-a narrative review. Int J Environ Res
Public Health 2022 Jul 05;19(13):8216 [FREE Full text] [CrossRef] [Medline]
3. Hassani K, McElroy T, Coop M, Pellegrin J, Wu WL, Janke RD, et al. Rapid
implementation and evaluation of virtual health training in a subspecialty hospital in
British Columbia, in response to the COVID-19 pandemic. Front Pediatr 2021
May;9:638070 [FREE Full text] [CrossRef] [Medline]
4. Kane CK, Gillis K. The use of telemedicine by physicians: still the exception rather than
the rule. Health Aff (Millwood) 2018 Dec;37(12):1923-1930. [CrossRef] [Medline]
5. Peters ZP, Cairns C, Davis D. Experiences related to the COVID-19 pandemic among
U.S. physicians in office-based settings, 2020-2021. Natl Health Stat Report 2022
Sep(175):1-7. [Medline]
6. Portnoy J, Waller M, Elliott T. Telemedicine in the era of COVID-19. J Allergy Clin
Immunol Pract 2020 May;8(5):1489-1491 [FREE Full text] [CrossRef] [Medline]
7. Yao P, Adam M, Clark S, Hsu H, Stern M, Sharma R, et al. A scoping review of the
unassisted physical exam conducted over synchronous audio-video telemedicine. Syst
Rev 2022 Oct 13;11(1):219 [FREE Full text] [CrossRef] [Medline]
8. Carrillo de Albornoz S, Sia KL, Harris A. The effectiveness of teleconsultations in
primary care: systematic review. Fam Pract 2022 Jan 19;39(1):168-182 [FREE Full text]
[CrossRef] [Medline]
9. Smith SM, Jacobsen JH, Atlas AP, Khoja A, Kovoor JG, Tivey DR, et al. Telehealth in
surgery: an umbrella review. ANZ J Surg 2021 Nov;91(11):2360-2375. [CrossRef]
[Medline]
10. Iancu AM, Kemp MT, Alam HB. Unmuting medical students' education: utilizing
telemedicine during the COVID-19 pandemic and beyond. J Med Internet Res 2020 Jul
20;22(7):e19667 [FREE Full text] [CrossRef] [Medline]
11. Davoodi NM, Chen K, Zou M, Li M, Jiménez F, Wetle TF, et al. Emergency physician
perspectives on using telehealth with older adults during COVID-19: a qualitative study.
J Am Coll Emerg Physicians Open 2021 Oct 14;2(5):e12577 [FREE Full text] [CrossRef]
[Medline]
12. Moore MA, Coffman M, Jetty A, Petterson S, Bazemore A. Only 15% of FPs report
using telehealth; training and lack of reimbursement are top barriers. Am Fam Physician
2016 Jan 15;93(2):101 [FREE Full text] [Medline]

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13. Pourmand A, Ghassemi M, Sumon K, Amini SB, Hood C, Sikka N. Lack of telemedicine
training in academic medicine: are we preparing the next generation? Telemed J E Health
2021 Jan;27(1):62-67. [CrossRef] [Medline]
14. Sharma R, Lee TH. Telemedicine is medicine: training medical students on virtual visits.
NEJM Catal Innov Care Deliv 2021 Sep 03;2(5) [FREE Full text]
15. Almathami HK, Win KT, Vlahu-Gjorgievska E. Barriers and facilitators that influence
telemedicine-based, real-time, online consultation at patients' homes: systematic literature
review. J Med Internet Res 2020 Feb 20;22(2):e16407 [FREE Full text] [CrossRef]
[Medline]
16. Berryman DR. Augmented reality: a review. Med Ref Serv Q 2012;31(2):212-218.
[CrossRef] [Medline]
17. Brigham TJ. Reality check: basics of augmented, virtual, and mixed reality. Med Ref
Serv Q 2017 Apr;36(2):171-178. [CrossRef] [Medline]
18. Eckert M, Volmerg JS, Friedrich CM. Augmented reality in medicine: systematic and
bibliographic review. JMIR Mhealth Uhealth 2019 Apr 26;7(4):e10967 [FREE Full text]
[CrossRef] [Medline]
19. Borresen A, Wolfe C, Lin CK, Tian Y, Raghuraman S, Nahrstedt K, et al. Usability of an
immersive augmented reality based telerehabilitation system with haptics (ARTESH) for
synchronous remote musculoskeletal examination. Int J Telerehabil 2019 Jun
12;11(1):23-32 [FREE Full text] [CrossRef] [Medline]
20. Levy JB, Kong E, Johnson N, Khetarpal A, Tomlinson J, Martin GF, et al. The mixed
reality medical ward round with the MS HoloLens 2: innovation in reducing COVID-19
transmission and PPE usage. Future Healthc J 2021 Mar;8(1):e127-e130 [FREE Full text]
[CrossRef] [Medline]
21. Hanna MG, Ahmed I, Nine J, Prajapati S, Pantanowitz L. Augmented reality technology
using Microsoft HoloLens in anatomic pathology. Arch Pathol Lab Med 2018
May;142(5):638-644 [FREE Full text] [CrossRef] [Medline]
22. Cooper L, Din AH, Fitzgerald O'Connor E, Roblin P, Rose V, Mughal M. Augmented
reality and plastic surgery training: a qualitative study. Cureus 2021 Oct
24;13(10):e19010 [FREE Full text] [CrossRef] [Medline]