# The Effectiveness of Virtual Reality Air‐to‐Ground Handoff Education in Realistic Operations on Learning Among Emergency Nurses in Taiwan

## TL;DR

This study shows that virtual reality training improves emergency nurses' preparedness and confidence in handling air-to-ground patient handoffs.

## Contribution

The study introduces VR simulation as an effective training method for air-to-ground patient handoff in emergency nursing.

## Key findings

- VR simulation significantly improved preparedness and psychological safety compared to traditional drills.
- Improvements were sustained for 8 weeks after the intervention.
- VR training could be extended to other emergency response professions for better interprofessional collaboration.

## Abstract

This study evaluated the effectiveness of virtual reality (VR) simulation training in enhancing emergency room (ER) nurses’ preparedness for air‐to‐ground patient handoff and psychological safety, defined as participants’ perceived confidence and comfort within the training environment.

Aeromedical transport is critical in regions with complex terrain or limited resources. The reception phase poses time‐sensitive and environmental challenges, and insufficient training increases the risk of handoff errors and patient harm. Existing programs focus mainly on in‐flight care, with little attention to reception. VR offers an immersive, standardized, and safe platform for reception training.

A quasiexperimental design using a nonrandomized, sequential cohort allocation by training date with two‐group repeated measures was employed.

Seventy‐six emergency nurses from a northern Taiwan medical center were assigned by training date to a traditional drill group (n = 33) or a VR simulation group (n = 43). The “H.A.N.D.O.F.F.” curriculum, based on the 2024 CDC air‐to‐ground handoff protocol, was implemented. Outcomes included the Air‐to‐Ground Patient Handoff Preparedness Inventory and Psychological Safety Scale. Data were collected at baseline, postintervention, and 8 weeks and analyzed using generalized estimating equations.

Baseline score refers to participants’ initial preparedness prior to the intervention, and no significant differences were found between groups at baseline (p > 0.05). Postintervention, the VR group reported significantly higher preparedness and psychological safety than controls (p < 0.001), and these improvements were sustained at the 8‐week follow‐up (p < 0.001).

This study demonstrated that VR simulation significantly improves preparedness for air‐to‐ground patient handoff, highlighting its practical value. Future applications may extend to military, police, and fire departments to foster interprofessional collaboration and enhance emergency response capabilities.