Virtual reality program hopes to turn the tide of violence in hospital EDs
By Mya Kordic
ABC Kimberley
Topic:Public Health
18m ago18 minutes agoSun 16 Mar 2025 at 12:00am
A woman uses virtual reality sticks to navigate an AI situation in virtual reality goggles.
The TIDE program uses virtual reality to equip participants to de-escalate aggressive incidents. (ABC Kimberley: Mya Kordic)
In short:
Staff training aims to combat rising violence in the health system by putting them into virtual situations with aggressive patients.
Participants take part in a virtual hospital "code black" and learn to de-escalate a situation.
What's next?
The program founder hopes the training can be expanded to health, social care and justice environments.
A man shouts at hospital staff, his aggression escalating as he waits for treatment.
"I've f****n had enough," he rages.
"You promised me I'd be out of here f****n ages ago."
But it's not real. To be precise, it's virtual reality.
This is a new program in Western Australia aiming to reverse rising violence in the health system by teaching trauma-informed care through simulated experiences.
Last month, an Australasian College of Emergency Medicine (ACEM) report described an increase in emergency department violence as a national crisis.
The Trauma Informed De-Escalation program (TIDE) has participants view a hospital "code black" or aggressive incident, through virtual reality before they are asked to de-escalate a situation using an artificial-intelligence patient.
A woman smiles as she presents at a training session.
Misty Carey leads a TIDE training session. (ABC Kimberley: Mya Kordic)
TIDE founder Misty Carey, a nurse for almost 30 years, said the training was a "big paradigm shift" in effective strategies to de-escalate situations, while teaching about trauma and stress response.
Ms Carey said trauma-informed care moved away from the perspective of "what's wrong with you?" to "what happened to you?"
"When you move it from a negative to a curiosity about what's driving behaviour, it's a powerful shift for how you approach that person and how they respond to the way you're treating them," she said.
A composite of images of soft toys, a training booklet and a whiteboard with the word "code black".
Some of the tools participants use to cope with a "code black". (ABC Kimberley: Mya Kordic)
Ms Carey said a code black was often overwhelming for young clinicians and the training could simulate their first experience in a safe environment.
Similar programs in the United States had produced positive outcomes, which Ms Carey said created a more therapeutic environment for all.
"Patients feel understood and seen and they often engage with the healthcare setting longer than they would have before," she said.
"Staff are feeling less burned out because they're not seeing all of that anger and aggression as genuine, they're now seeing it as a sign and symptom of the person's trauma."
Training has started in WA, including sessions this week in Broome.
Ms Carey said that while trauma-informed care did not solve every escalating situation, she was hopeful TIDE could help restore calm in health, social care and justice environments.
"Whether it be nurses, healthcare, corrections, police, social services … anywhere where our perceptions and our reactions have long-lasting impacts on that person in front of us," she said.
Approach ensures patients 'seen'
WA Health Consumers Council executive director Clare Mullen said the trauma-informed approach meant the patient and their context was "seen" and understood.
She said patients' frustrations could be elevated by past trauma, unfamiliar settings or their health condition.
Misty Carey applauds a smiling participant wearing a headset and holding controls.
Ms Carey applauds a TIDE participant's efforts in the virtual environment. (ABC Kimberley: Mya Kordic)
Ms Mullen said a trauma-informed approach meant there was recognition for the experiences of both healthcare staff and patients.
"Healthcare staff are often facing quite challenging situations on a day-by-day basis and we've been strong champions of making sure that compassion is afforded to everyone,"
she said.
ED aggression on the rise
The ACEM's latest data showed more than 50 per cent of emergency doctors reported physical violence in their department daily or weekly.
ACEM president Dr Stephen Gourley said the increase in violence was "complex" and derived from factors including overcrowding, longer wait times and a lack of beds for mental health patients.
A man with his arms crossed smiles at the camera.
Dr Stephen Gourley. (ABC Alice Springs: Emma Haskin)
Dr Gourley said, while he supported a trauma-informed approach to maintain patient dignity, it might not have a significant impact on people who are drug affected or have a serious mental health injury.
"The challenge is for it to work appropriately. The person you're dealing with, who is escalating, needs to have some capacity,"
he said.
Following its report, Dr Gourley said the ACEM was calling for an increased security presence in hospitals and reduced wait times.
Dr Gourley said the impact of violence had been a significant blow to the system.
"It's eroding the morale of the people working on the front lines [and] it's making people leave the profession, which is actually an absolute tragedy," he said.
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Posted18m ago18 minutes agoSun 16 Mar 2025 at 12:00am
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