Drug overdoses can happen anywhere, which is why Narcan — a name brand life-saving opioid overdose reversal medication — is widely available for free. But training is more limited by instructor availability, and there's no real way to provide hands-on experience beyond a mannequin dummy.
Illinois State University is trying to change the way people experience opioid overdose reversal training by deploying a virtual reality app to do the job. Through a partnership with Southern Illinois University Carbondale and OSF HealthCare, and using an Illinois Innovation Network grant, ISU alum Matthew Kase has been developing an Apple Vision Pro prototype app. It's being researched for effectiveness, but he and the other collaborators are hoping it will become mainstream.
“You're essentially coming upon this, this person that has overdosed on opioids, and then you have to go through the steps, sort of one by one,” Roy Magnuson, director of emerging technologies for instruction and research at ISU’s Office of Technology Solutions, said about the mixed reality demonstration.
Magnuson, also an associate professor of creative technologies at the ISU Wonsook Kim College of Fine Arts, taught the course in which Kase developed the Narcan app. He’s also taken the training on several occasions since it became usable — though it’s not yet available to the public.
“You're looking at their fingernails and discoloring and their eyes,” Magnuson said. “You're having to do mouth-to-mouth. So you literally have to, like, lean over and you're performing these things.”
But it’s just that: a performance. Nobody is having an overdose.
For people who have used a VR headset or are familiar with extended reality, the entire experience of the Narcan training Kase and ISU are developing happens within the confines of the Apple Vision Pro headset screen.
“It creates almost like a hologram of someone who is overdosed,” said Scott Barrows, director of OSF HealthCare’s Innovation and Design Lab and a collaborator on the project.
OSF is hoping to use the app in rural communities, where Barrows said access to Narcan and opioid overdose reversal training is limited.
“If someone overdoses, it might take 40 minutes for an ambulance to get there, “ he said. “There might not be available Narcan dispensers, so it's really critical to educate and to involve and engage not just the health care providers and first responders, but members of the community, school kids, high school students.”
Immersive experience for better outcomes
Wasantha Jayawardene, an assistant professor of public health in the School of Human Sciences at Southern Illinois University Carbondale, conceived the idea for a Narcan VR tool.
Before connecting with ISU, he’d been conducting research on a virtual Narcan training that he said showed promising results, but still needed improvement.
“People gain knowledge and skills, but still, they are reluctant to go and intervene when they see someone who needs help,” he said the study found.
That led Jayawardene to mixed reality, he said.
“Because that can create a more realistic situation during the training,” he explained. “So then, after people take that training, they may feel more comfortable attending and helping a victim.”
He called Magnuson when he learned of ISU’s virtual reality programs and department. Once the partnership started, Magnuson approached Kase to develop the app since Kase has a background in neuroscience.
As one of a small batch to have taken the training so far, Magnuson said the first time he took the roughly 10-minute training he started to feel emotional.
“You see all these things that give you this, like, real sense of embodiment and being in that experience: the audio kind of kicking in and hearing these things behind you, and you get the sense that there's actually, you know, police outside the room,” he said.
In a word, it’s “effective,” Magnuson said. “You've gone through this whole arc. You're like, ‘Man, thank god this person's stable.’”
An educational game
Kase said his goal wasn’t to make the training “tear-jerking” and he hadn’t thought of the simulation as emotional — though that's not a bad thing. His goal, he said, has always been to educate people on this way to save someone’s life.
“There's a whole field of games that you know aren't Mario and collecting coins, they're, you know, serious games, which are used for educational purposes,” he said, adding that’s how he views the app he’s still tinkering with.
He pointed out the purpose of this game is the same as any Narcan training: to take people through the series of steps that lead up to and follow Narcan administration. He pointed out that spraying Narcan into someone’s nostril is a fairly easy job that takes seconds. The training is around 10 minutes because of all the surrounding specifications and questions that arise.
“What to do when you call 911?” he said. “What [do you] say to the operator? When do you call 911 versus when do you deliver the Narcan? After you deliver the Narcan, you have to deliver rescue breaths. How many times can you deliver the Narcan? Is it dangerous to deliver the Narcan multiple times?”
First aid training techniques that health professionals such as EMTs and other first responders might use also are given via instructor.
“Checking for responsiveness, and knowing how to check someone for responsiveness, digging your knuckles into their sternum or pinching their fingernails,” said Kase, are all examples of commands the instructor gives in the demo.
Future uses
Since the Apple Vision Pro uses eye-track and newer technologies, there are no props or hand controls, as with other VR headsets such as Quest. The Vision Pro also has a high price tag — $3,500 — but Magnuson said it was important that the team used the newest tech to make their app.
“Because we're throwing a dart at, you know, 2, 3, 4, 5 years down the line, Do these things work? Does eye tracking work? Does all this fidelity work?” he said.
Trials and research on the product are currently being conducted and all involved who spoke to WGLT said it’s not certain to become mainstream — but that’s certainly the hope.
“In an ideal situation, I would love to see community centers and substance abuse centers everywhere having these headsets and access to an application like this, so that anyone can just walk in at any time and train themselves on how to respond to to an overdose,” said Kase, adding he’d like to see the tool become available in schools and other institutions as well.
Barrows with OSF said he’s thinking of the project as a campaign. Even if people can’t access an Apple Vision Pro — which he’s hoping part of the campaign will help people access — training should be implemented in rural communities through other non-instructor-dependent means.
“It's not an answer for everything, but I think it's a valuable piece of how we're going to take on this crisis,” Barrows said. “It is very scary.”
