VR in the Emergency Room: Sutures, Fractures, and Dressings Without Sedation

The emergency department: where pain is urgent

The emergency department is the healthcare setting where procedural pain is most frequent, most intense, and most underestimated.

Wound suturing. Fracture reduction. Burn dressings. Removal of foreign bodies. Drain placements. Procedures that hurt and are often performed with minimal analgesia because "there's no time" or "it's not worth sedating for this".

The result: patients who suffer more than necessary. Children who scream. Adults who tense up. Procedures that become more difficult because the patient cannot stay still.

The sedation dilemma in the ED

Procedural sedation in the emergency department exists, but it has practical limits:

It requires continuous monitoring (pulse oximeter, ECG)
A physician dedicated to sedation is needed
The patient must remain under observation afterward
It occupies a bay for 1-2 hours for a 10-minute procedure
It is not always justified for "minor" procedures

The result is that many procedures are done with insufficient analgesia. Not out of negligence, but because of resource limitations.

VR as an immediate solution

Immersive therapy fits perfectly into the emergency department context because:

It is immediate. No pharmacological preparation is needed. No waiting for the drug to take effect. Headset on, patient immersed, procedure.

It does not require additional monitoring. The patient is awake, oriented, with vital signs unchanged. No post-procedural observation is needed.

It does not tie up resources. No physician dedicated to sedation is needed. The nurse performing the procedure can also manage the headset.

It is repeatable. If the procedure is long (complex dressing, extensive suturing), VR works for the entire duration without losing effectiveness.

Specific use cases

Wound suturing

The patient does not see the suture needle, does not see the wound, does not see the blood. Local anesthesia does its job on the physical level, VR on the emotional/cognitive level. The result: a patient who stays still, cooperates, and has the suturing performed optimally.

Fracture reduction

Closed reduction of a fracture is one of the most painful procedures in the ED. VR does not replace pharmacological analgesia, but complements it. The patient is partially distracted from residual pain and less musculoskeletally tense, making the maneuver easier.

Burn dressings

Burn dressings are long and extremely painful. The first study on VR in the clinical setting (SnowWorld, 2000) was precisely on burn patients. Its effectiveness has been demonstrated for over 20 years.

Pediatric procedures in the ED

Children with wounds that need suturing, fractures, or foreign bodies. VR turns a panic scene into a manageable procedure, often without the need for sedation.

Removal of foreign bodies

Splinters, glass, thorns. Short but painful procedures where VR is perfect: high effectiveness for limited duration and localized pain intensity.

The impact on ED workflow

The emergency department runs on time. Every minute a patient occupies a bay is a minute less for the next one.

VR has a positive impact on workflow:

Fewer procedural sedations = less post-observation time = bay freed sooner
Faster procedures = patient still = fewer attempts = reduced procedure time
Fewer anesthesia consult requests = greater autonomy for the ED team

The ED protocol

Triage identifies procedures that will benefit from VR (suturing, dressing, reduction, needle procedures)
Headset available in the procedure bay (already sanitized, ready to use)
Offer to the patient: "We have a headset that will help you not think about the procedure"
Setup: 20 seconds. Quick experience selection (2-3 preloaded options)
Procedure performed as normal
Headset removed, sanitized, ready for the next patient

Added time to the workflow: under 60 seconds.

Not for all emergencies

VR in the ED has clear indications:

Yes: sutures, dressings, needle procedures, reductions with analgesia, stitch/staple removal, superficial drains, minor ophthalmic procedures.

To evaluate: major trauma (the patient may be too agitated/confused), altered states of consciousness.

No: life-threatening emergencies (where every second counts and the headset would get in the way), hemodynamically unstable patients, reduced Glasgow Coma Scale.

SnowWorld: where it all began

It is worth remembering that therapeutic VR was born precisely for acute pain. SnowWorld, created in 2000 at the University of Washington, was a virtual environment of ice and snow designed for burn patients during dressing changes. The results were so striking that they opened an entire field of research.

25 years later, that promise has become reality in ready-to-use, validated tools accessible to any facility.

The emergency department is where pain is most urgent and resources are scarcest. Immersive therapy offers a solution that requires no additional resources: just a headset and 20 seconds.