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

The Emergency Room: Where pain is urgent

The emergency room is the healthcare environment where procedural pain is most frequent, most intense, and most underestimated.

Wound sutures. Fracture reductions. Burn dressings. Foreign body removals. Drainages. Procedures that hurt and are often performed with minimal analgesia because "there is no time" or "it is not worth sedating for this."

The result: patients who suffer more than necessary. Screaming children. Twitcing adults. Procedures that become more difficult because the patient cannot stay still.

The sedation dilemma in the ER

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

Requires continuous monitoring (pulse oximeter, ECG)
Requires a dedicated doctor for sedation
The patient must remain under observation afterward
Occupies a cubicle for 1-2 hours for a 10-minute procedure
It is not always justified for "minor" procedures

The result is that many procedures are performed with insufficient analgesia. Not out of negligence, but due to resource limits.

VR as an immediate solution

Immersive therapy fits perfectly into the emergency room context because:

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

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

It does not occupy extra resources. No dedicated doctor is needed for sedation. 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 efficacy.

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 stable, collaborative patient, with the suture performed optimally.

Fracture reduction

Closed reduction of a fracture is one of the most painful procedures in the ER. VR does not replace pharmacological analgesia, but complements it. The patient is partially distracted from the residual pain and has less muscle tension, facilitating the maneuver.

Burn dressings

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

Pediatric procedures in the ER

Children with wounds to be sutured, with fractures, with foreign bodies. VR transforms a scene of panic into a manageable procedure, often without the need for sedation.

Foreign body removal

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

The impact on ER flows

The emergency room operates on time. Every minute a patient occupies a cubicle is one minute less for the next one.

VR positively impacts flows:

Fewer procedural sedations = less post-observation time = cubicle freed up sooner
Faster procedures = still patient = fewer attempts = reduced procedural time
Fewer requests for anesthesiology consultation = autonomy of the ER team

The ER protocol

Triage identifies procedures that will benefit from VR (suturing, dressing, reduction, needle procedures)
Headset available at the procedural station (already sanitized, ready for use)
Proposal to the patient: "We have a headset that will help you not to think about the procedure"
Setup: 20 seconds. Quick selection of the experience (2-3 pre-loaded options)
Procedure performed normally
Headset removed, sanitized, ready for the next one

Time added to the workflow: under 60 seconds.

Not for all emergencies

VR in the ER has clear indications:

Yes: sutures, dressings, needle procedures, reductions with analgesia, removal of stitches/staples, superficial drainages, minor ophthalmological procedures.

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

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

SnowWorld: Where it all started

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 wound dressings. The results were so marked that they opened an entire field of research.

25 years later, that promise has materialized into ready-to-use, validated tools accessible to any facility.

The emergency room 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. Lemons in the Room is designed exactly for this: 10 seconds to start, offline operation, no login. The medical device designed for the chaos of the department.