Abstract:

Professionals operating in high-risk environments must perform complex tasks while managing significant cognitive and physiological stress. The ability to regulate stress and maintain effective decision-making under pressure is therefore a critical competence in operational settings. However, conventional training approaches often face limitations in reproducing the intensity, uncertainty, and dynamic nature of real operational scenarios while ensuring safe learning conditions.

CARE-XR (Combat Aid and Response Environment – Extended Reality) is an immersive training program designed to support the development of stress regulation and decision-making skills in high-risk contexts through Virtual Reality (VR). The program emerged from a preliminary research phase combining a systematic review of the literature with a Delphi consensus methodology involving subject matter experts in operational training, human performance, and immersive technologies.

The systematic review examined existing evidence regarding stress exposure, performance demands, and training approaches in high-risk operational environments. Building on these findings, a Delphi process was conducted to identify operational contexts associated with the highest stress impact during training and performance. The results indicated that Tactical Combat Casualty Care (TCCC) scenarios were perceived as the operational environment generating the highest levels of stress, reaching a consensus of 97% among participating experts.

Based on this consensus, CARE-XR was developed as an immersive training framework focused on TC3 operational scenarios. The program integrates realistic VR simulations with structured training procedures that require participants to perform critical tasks while managing stress responses, maintaining situational awareness, and making rapid decisions under pressure.

By recreating complex operational environments with high ecological validity, VR enables repeated exposure to demanding situations within a controlled and safe training setting. CARE-XR emphasizes the development of both technical and non-technical competencies, including stress regulation, attentional control, adaptive decision-making, and performance under pressure.

The use of VR training environments represents an innovative approach to professional preparation, bridging the gap between theoretical instruction and real-world operational demands. By integrating scientific evidence, expert consensus, and immersive technologies, CARE-XR supports training in high-risk professions where performance under stress is critical. The framework provides a flexible and scalable model designed to enhance preparedness, resilience, and decision-making in operational contexts characterized by elevated stress and time-critical demands.

Keywords:

Training, Extended Reality, Simulation, Stress Regulation.