CARE-XR: Saving Lives in Combat Environments with a Virtual Reality Framework

Abstract

[Abstract] The CARE-XR project (Combat Aid \& Response Environment – Extended Reality) presents a practitioner-driven framework for immersive training in Tactical Combat Casualty Care (TC3). Grounded in evidence from a prior systematic review and a Delphi study with Portuguese Special Operations Forces (SOF), CARE-XR combines XR technologies with bio-adaptive affective computing and participatory co-design to address operational needs for realism, adaptability, feedback, and teamwork. The manuscript outlines a phased development process, needs assessment, iterative co-design with SOF, and validation planning, and details the technical components: XR headsets, biofeedback wearables, haptic devices, authoring tools, affective algorithms and simulation management systems. Rather than presenting an efficacy trial, this work is framed as a design and analysis contribution, articulating design requirements, system architecture and ethical considerations. In practical terms, CARE-XR lays the groundwork for a modular and scalable foundation to evaluate transfer of TC3 skills and stress-regulation to live operational contexts.