Virtual reality-based disaster preparedness training for health professionals and first responders

Background Virtual reality (VR) enables safe, repeatable rehearsal for rare, high-risk disasters, but evidence spans health professions, emergency response, disaster management, and educational technology. Objective To synthesize how VR and interactive virtual simulations are designed, implemented, and evaluated for health professionals, learners, and first responders, and to assess the certainty of reported educational and performance outcomes. Methods Following PRISMA 2020, the original Web of Science, Scopus, and Google Scholar search covered 1 January 2000–31 December 2025. Retrospective PubMed/MEDLINE and CINAHL searches on 12–13 September 2026 used the same cutoff. Of 638 update records, 572 unique records were screened and 50 reports sought; six were not retrieved, 44 underwent full-text assessment, and 33 database reports were eligible. Citation checking added one companion article. The 34 update reports represented 29 new studies; the final synthesis comprised 54 studies in 59 included reports. Original screening was joint; update title/abstract screening used separate blinded worksheets, reconciliation, and a criteria-consistency audit. The Mixed Methods Appraisal Tool informed study appraisal; narrative synthesis and GRADE were used without meta-analysis. For clarity, the original corpus comprised 25 studies, whereas the expanded evidence base comprised 54 studies represented by 59 reports. Results Participants included health-professions learners and personnel, first responders, community volunteers, and other adults; analytic samples ranged from 6 to 739. Applications addressed triage, evacuation, disaster decisions, psychological first aid, clinical reasoning, and team or command rehearsal. Objective outcomes often improved from baseline or were comparable with active alternatives, but superiority was inconsistent. Confidence, self-efficacy, immersion, and acceptability were frequently favorable but mainly self-reported. Small convenience samples, nonrandomized or uncontrolled designs, sparse long-term follow-up, variable instruments, and incomplete reporting limited inference. Certainty was low for objective performance and knowledge and very low for self-reported, implementation, and stress-related outcomes. Conclusions VR is a promising adjunct, not a demonstrated replacement, for live and mannequin-based disaster training. Its strongest roles are repeatable rehearsal, formative assessment, and preparation before resource-intensive exercises. Standardized outcomes, psychologically safe implementation, adequately powered comparisons, and longer follow-up are needed before claims of superiority or real-world transfer. Registration The review was not prospectively registered.