Second Life is a perfect place where hardly anyone gets old or sick. Nevertheless, some healthcare providers are using the virtual world to solve real-world healthcare problems.

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Judi Smith heads up training in Second Life for Children's Memorial Hospital in Chicago. Here she is with her Second Life avatar, "Judi Carver."

In Chicago, Children's Memorial Hospital uses Second Life, with its three-dimensional software representations of landscapes, buildings, and vehicles, for disaster preparedness training, to show employees how to evacuate patients in an emergency. Meanwhile, disabled people use Second Life for peer support, helping one another with the emotional, social, and other problems they encounter in the real world. In both cases, people in Second Life interact using avatars, software representations of themselves or a character of their choosing.

Developed and operated by Linden Lab, the six-year-old service has about 650,000 active users, who turn to it for business, games, live music, and more. IBM, Cisco, and Sun Microsystems are among the companies with a presence in Second Life. The University of Texas recently announced it's building a virtual campus in Second Life, and the U.S. Armed Forces uses Second Life for training.

Staff at Children's Memorial started thinking just after Sept. 11, 2001, about how they would get the kids out of the hospital and to safety in case of fire, tornado, terrorist attack, or other disaster. The hospital also needed a way to do simulations without using the hospital itself, which can't be shut down for training, said training manager Judi Smith.

They tried tabletop drills, in which participants act out a disaster while sitting around a table, but found those exercises lacked realism. That's when the hospital turned to computer simulations. "Health people are physical, tactile people," Smith said. "They can talk about things and read about them, but the closer you can get to doing things in the real world, the better off you are."

Children's Memorial hired a contractor to build a Second Life simulation of its campus and building. The simulation included the outside street, a Starbucks on the corner frequented by hospital staff, as well as a nearby parking garage that might be used to shelter patients during an emergency. The builders included interior details, such as a purple sculpture in the lobby and decorated bulletin boards throughout the building to help hospital staff orient themselves in the virtual world. For realism, they used blueprints of the hospital, photos taken on-site and imported into Second Life, and images from Google Earth.

During the training exercise, a team of about nine hospital staff members, drawn from nursing, security, and administration, logs into Second Life and spends 10 minutes learning the basics of how to navigate and communicate in the virtual world. Then, the drill begins.

The trainees go into the exercise cold, with minimal coaching on what to expect. They're invited to participate in a training drill but aren't told they're going to be using Second Life or that they'll be working on an evacuation and transportation plan, Smith said. "We intentionally selected people with little or no experience with virtual situations," she said. That was because one major goal of the Second Life drills is to teach "situational awareness"--a security term for being aware of your surroundings and alert for out-of-place details that might signal a threat.

In the simulation, a suspicious object--a knapsack-- is left on a corridor floor and the trainers leave it to the trainees to find the suspicious object, identify it as a threat, and then evacuate simulated patients from the hospital, just as they would in real life.

The "patients" are automated software manikins, which Smith called "mannies." They don't do much--just lie in bed. Trainers can indicate the level of a patient's injury or illness using colors: High-acuity patients are colored red, they need to be carried out of the hospital, and someone must stay with them at all times.

The goal of the exercise--like a game, but with a serious purpose--is to get all the mannies out of the hospital and put them into a row of ambulances waiting at the front of the hospital.

Through the drill, hospital staff learn first-hand about procedures for evacuation, in a visceral way that's not achievable just reading about them or doing tabletop rehearsals, Smith said

For example, one procedure calls for staff to put a pillowcase in front of the door of each room they check to signal that there are no patients in the room; one staff member said he understood the need for the rule after seeing how it slows things down to have to check rooms multiple times. Similarly, security staff must check rooms, but the hospital has a rule that they can't enter a room with a patient in it without having a nurse present. "You see the security guy looking around and seeing no nurse and having to find one," said Smith. That teaches security staff that the need to find a nurse isn’t just a checklist item; it can be a significant obstacle to evacuating the hospital quickly.

While the scenario rehearsed in Second Life is for one, specific emergency, the lessons can be applied to many situations. For example, during the H1N1 flu outbreak in spring, the hospital got hit with a high volume of patients. Hospital staff had learned from the Second Life drill the value of having a chain of command and sticking with it, Smith said, and they applied it to that situation.

Children's Memorial Hospital paid $25,000 to Centrax, a Chicago e-learning company and Second Life solution provider, to build the simulated hospital. Hospital executives selected Centrax after meeting company president Edward Prentice III at the Executive Learning Exchange, a local training conference. They were impressed that the company understood what Children Memorial's goal was--to build a business area for virtual training, not a flashy display for publicity purposes.

"We were looking for someone who would treat this as a business process and not have their own agenda," Smith said. Several other solution providers Children's Memorial approached pressured the hospital to build a virtual reproduction of the hospital executive offices in Second Life, to impress the hospital's CFO. But Children's Memorial felt those areas were unnecessary to reproduce in Second Life, because they weren't needed for training, and Centrax agreed.

Children's Memorial also wanted to lease its own server--known in Second Life jargon as an "island"--rather than rely on a server that Centrax leased. The hospital wanted to be able to use the server without having to get Centrax's permission to access or modify it.

The Second Life simulation has advantages over real-life simulations using actual facilities, Smith said. Drills using real-life facilities, while valuable, are hugely expensive and disruptive, involving assembling large numbers of participants and breaking into their schedules for long periods, as well as shutting down real-life facilities to normal traffic. Purpose-built training software doesn't have those limitations, but it's harder than Second Life to re-use. The Second Life virtual hospital, now that it's built, can be used for other kinds of training exercises, Smith said.

Children's Memorial did encounter a problem with Second Life--the software requires midrange or high-end PCs to run, and the hospital's computers didn't have the horsepower. The solution was to use a local Internet cafe for coaching and use computers at Centrax for the training exercise. The hospital bought one laptop with Second Life specs for Smith and a collaborator to use.

As part of the next phase, Children's Hospital plans to outfit an on-site training lab with PCs powerful enough to run Second Life, as well as lease more server space--"buying more land," in Second Life jargon--to expand the virtual training site from one island to three.

Professionals aren't the only ones using Second Life for healthcare. The service is also used for peer support.

Virtual Ability is one of the biggest peer-support groups in Second Life. It has three islands and serves a community of about 400 people with real-life disabilities, including physical, sensory, emotional, and mental problems. Virtual Ability members have a broad range of physical limitations based on their disability. Some are so severely disabled they can't leave their homes, while at the other extreme, are people who lead relatively normal lives, like a professional race-car driver who is hearing-impaired. Some members are vision-impaired, some suffer from paralysis, some are limb amputees, or have severe arthritis.

Members provide emotional support and share practical advice for real-world problems.

For example, Virtual Ability president Alice Krueger, a 60-year-old former schoolteacher with multiple sclerosis, talks about meeting another woman with MS who lived in her state. "She had a horrific situation at home. She had been married, but her husband didn't want to deal with a woman in a wheelchair, and dumped her in their married daughter's house and left," said Krueger, whose Second Life name is "Gentle Heron."

The daughter has children of her own, and she and her husband both work full time. They put her mother in the basement, with the bathroom and kitchen upstairs, out of reach of the woman, who is weak, suffers from vertigo, and has some "intellectual difficulties" caused by the MS, Krueger said.

One day, Krueger received a phone call from the woman. The woman had been left at home in the basement, while the rest of the family left on vacation. The woman hadn't eaten in two days and had no toilet downstairs.

Krueger said she called the local emergency services number for her friend, and stayed in touch with the woman in Second Life until Krueger heard emergency workers arrive. “They got her out of that unlivable situation, and, with the help of social services, found her a different place to live. Now when I talk to her in SL, she's much happier. She could have died in that former situation,” Krueger said.

The last thing Krueger heard, her friend had acquired a Second Life boyfriend who invited the woman to move in with him in real life, Krueger said. "Because she had friends in Second Life, she knew where to turn to," Krueger said. "Second Life literally saved her life. It certainly turned her life around

Virtual Ability is a 501(c)(3) not-for-profit corporation, incorporated in the state of Colorado. It also provides a social outlet for many disabled people, particularly those who hide their disabilities in the real world, or whose mobility is limited, or who feel so stigmatized that they can't relate in real life, Krueger said. Examples of the stigmatized group include people with severe facial disfigurement and people with autism whose behavior would be labeled bizarre by the mainstream world.

Second Life gives housebound disabled people the opportunity to travel--or experience the illusion of travel--to places within the virtual world, Krueger said. And Virtual Ability hosts lectures and presentations on health issues.

"Second Life gives people who are homebound and can't get out a way to be creative, to share beauty, to share insight, to share their knowledge and wisdom and skills with other people," said Patricia Anderson, an emerging technologies librarian with the Health Sciences Libraries at the University of Michigan.

Anderson, who goes by the Second Life name "Perplexity Peccable," helps maintain a Web-based database of Second Life healthcare support groups.

"I've been very impressed with the ability of Second Life to support people who don't have good access to community and healthcare support in real life," she said.