Holo-BLSD is a mixed reality self-learning and self-assessment tool for first responders’ emergency response to cardiac arrest. The system provides an experiential learning approach by integrating a cardiopulmonary resuscitation manikin with a virtual recreation of the emergency scenario. The training course includes the phases of education (teaching the BLSD procedure), training (to practice the learned concepts) and final assessment of the acquired skills.

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A primary educational goal in resuscitation is to train both laypersons and professionals in BLSD (Basic Life Support and Defibrillation) to improve the survival of patients in cardiac arrest. In addition, training in BLSD is required by law in sports and industry and is a fundamental part of training in medicine and nursing. In this context, Holo-BLSD offers itself as an alternative to the standard time-consuming and costly courses with instructors.


The standard approach to BLSD training is instructor-led courses that include theoretical lectures and hands-on demonstrations with CPR manikins. A major disadvantage of these courses is that they are time-consuming (delivery, transportation of participants to the course site) and costly (rental/use of space, instructors’ fees). An effective alternative, for both lay and health professionals, is self-learning content, which, as several scientific studies have shown, has comparable learning outcomes to traditional courses and allows for a reduction in usage costs.

In this context, Holo-BLSD allows the adaptation of the procedure to be taught to different categories of learners and (through its virtual content) the simulation of different emergency scenarios. The use of a standard CPR manikin supports hands-on learning of BLSD procedures, and the teaching and practice phases help learners monitor their training progress, which can be automatically assessed. In addition, the system enables a reduction in training costs by eliminating the need for an instructor to be present, allowing learners to complete the program at their own pace and repeat as needed, and offsetting application costs by using one device to train multiple people.

Current Technology Limitations

Computer-based BLSD self-learning methods have recently attracted considerable interest from the public and software companies. In particular, Virtual Reality technologies have been considered in several solutions because of their ability to incorporate multimedia and interactive content into the training process and to virtually reconstruct the emergency scenario, giving the user the feeling of being immersed in the training experience. The current tools still have some limitations. None of them fully covers the different phases of the user learning process (i.e., receiving instructions on the procedures to be performed, practicing the procedure, and evaluating the skills achieved). The use of immersive VR raises the issue of safety and confidence of the users to move in the physical training environment, since they cannot see the real environment. The few applications proposed in Augmented Reality (and which therefore overcome these safety issues) are often run on smartphones and have very limited content and interaction capabilities. The use of Hololens as AR technology allows hands-free use of Holo-BLSD and the integration of various natural interaction techniques that make the use of the tool simple and immediate.

Killer Application

The main applications of this technology are as follows:

  • Training on BLSD procedures for laypersons and medical professionals.
  • Training, through the virtualization of the emergency scenario, in different environments (inside and outside the hospital, in industry, in sports)
  • Possibility to adapt the sequence of procedures to be trained to the specific needs of the context (e.g. to adapt the environmental safety measures to the industrial or construction environment, or to simulate different conditions of the patient to be treated).

Our Technology and Solution

Holo-BLSD leverages the Microsoft HoloLens device and the ability to interact naturally with speech, gestures, and body movements to augment a low-cost standard CPR manikin with interactive holographic contents that recreate a realistic emergency scenario.

Since Holo-BLSD must allow different categories of users (lay, professional) to experience BLSD procedures in their entirety, in different scenarios, and on different clinical cases, the software was designed to be flexible enough to support these different configurations and to facilitate the introduction of new elements (e.g., for team training). In addition, to simplify the use of the system in different real-world training environments, Holo-BLSD allows the virtual environment to be redesigned and the elements within it to be repositioned from within the application.

To minimize the learning curve when using the Hololens interaction device and to ensure that learners can focus on the procedures to be learned, the system also allows users to familiarize themselves with the interaction system through a dedicated training session that can be repeated until the learner gains the necessary confidence in the hardware devices.

In conclusion, our tests have shown that the tool is effective for education, as there are no significant differences between the results of students attending a standard course with a teacher and a course with Holo-BLSD. The tool is also reliable for assessment, as there are no significant differences between the scores of human experts and those of the tool when using a common metric.


Holo-BLSD is a tool that comprehensively covers the different phases of the user learning process (teaching the procedure, training and evaluating the acquired skills). The use of MR makes it possible to virtually recreate the intervention context (including a CPR manikin to ensure experiential training), with the possibility of simulating different real scenarios and clinical conditions of the patient. In addition, the system allows for a reduction in training costs and flexible training management that can be adapted to the needs and schedule of the trainees.


The development of the system consists of three main points in addition to increasing the TRL of the current prototype version of the system.

The first is the update of the software and the redesign of the HCI component in light of the availability of the Hololens 2 version, which offers new features of significant interest and improves on those offered by the Hololens 1 version on which the software currently runs. The second point is the possibility of implementing adpative learning approaches that automatically adapt the learning path and the content conveyed to the needs and abilities of the learner. The third point concerns the integration of team training methods, especially for the professional field.

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