Potential perils of peri-Pokémon perambulation: the dark reality of augmented reality?

Oxford Medical Case Reports, Oct 2016

Recently, the layering of augmented reality information on top of smartphone applications has created unprecedented user engagement and popularity. One augmented reality-based entertainment application, Pokémon Go (Pokémon Company, Tokyo, Japan) has become the most rapidly downloaded in history. This technology holds tremendous promise to promote ambulatory activity. However, there exists the obvious potential for distraction-related morbidity. We report two cases, presenting simultaneously to our trauma center, with injuries sustained secondary to gameplay with this augmented reality-based application.

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Potential perils of peri-Pokémon perambulation: the dark reality of augmented reality?

Potential perils of peri-Pokémon perambulation: the dark reality of augmented reality? Bellal Joseph 1 David G. Armstrong 0 0 Department of Surgery, Southern Arizona Limb Salvage Alliance , Tucson, AZ , USA 1 Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Arizona , Tucson, AZ , USA Recently, the layering of augmented reality information on top of smartphone applications has created unprecedented user engagement and popularity. One augmented reality-based entertainment application, Pokémon Go (Pokémon Company, Tokyo, Japan) has become the most rapidly downloaded in history. This technology holds tremendous promise to promote ambulatory activity. However, there exists the obvious potential for distraction-related morbidity. We report two cases, presenting simultaneously to our trauma center, with injuries sustained secondary to gameplay with this augmented reality-based application. INTRODUCTION The dramatic increase in smartphone adoption and computing power on ever more capable mobile computing platforms has been associated with a rise in reports of distraction-related injury and death [ 1–5 ]. Recently, the layering of augmented reality information on top of smartphone applications has created further levels of user engagement and popularity. One augmented reality-based entertainment application, Pokémon Go (Pokémon Company, Tokyo, Japan) has become the most rapidly downloaded in history (Fig. 1) [ 6 ]. This technology holds tremendous promise to promote ambulatory activity. However, there exists the obvious potential for further distraction-related morbidity. We report two cases, presenting simultaneously to our trauma center, with injuries sustained secondary to engagement with this augmented reality-based application. CASE REPORT Our first case involved four passengers involved in a single vehicle rollover accident. Patient number 1, the driver of the pickup truck, was a 19-year-old male. Alert and oriented upon admission to the trauma center, he volunteered that while piloting the pickup truck he lost control at a speed of ~40 miles per hour. He reported that he was ‘hunting Pokémon’ while driving and got distracted when he found one ‘sitting across the road’ in his direct path. Seeing this, he attempted to ‘flick his Pokémon ball to capture the [aforementioned] Pokémon’ and lost control of the vehicle, rolling it and ejecting passengers 2, 3 and 4 from the bed of the pickup. Per reports from emergency personnel, the other passengers rolled the vehicle off of the patient. A CT scan of the head was identified a small focus of subarachnoid hemorrhage; however, there was no evidence of increased intracranial pressure and Glasgow coma scale of 15. An abdominal scan identified a 3.9 × 1.8 cm liver laceration involving the caudate lobe. Patient number 2 complained primarily of headache and back pain upon presentation. Per emergency personnel, he was found underneath the tire of the truck, which was on top of his left chest. The patient had two scalp lacerations and the remainder of his work up was negative. Patients 3 and 4 also had non-specific complaints of neck and lower back pain following pickup-bed ejection. Both had reported ‘blacking’ out, but after a thorough work up were fortunate enough to leave the unit with no injuries. Our second case, a 58-year-old woman involved in a single motor vehicle accident, presented to the same trauma unit contemporaneously with the first case. She collided with a utility pole after swerving off the road to avoid hitting a pedestrian. She presented with severe pelvic pain and was found to have multiple pelvic fractures that were treated non-operatively. Scene reports from bystanders and Emergency Medical Services indicated that the aforementioned pedestrian (uninjured) was engaged in a game of Pokémon Go and had wandered into the middle of the street to catch a Pokémon, thereby precipitating the car versus pole collision. DISCUSSION Mobile entertainment applications such as Pokémon have the laudable ability to promote user engagement and increased physical activity [ 7 ]. Still other types of connected wearables have helped both consumers and clinicians dose activity much as we might dose a drug [ 8, 9 ]. Rapidly evolving technologies that overlay information on top of a natural environment can also likely be beneficial in a wide variety of environments [10]. However, there exists a sinister side to these types of connected devices as well. Entertainment apps may promote more sedentary behavior [ 11 ]. Mobile and mobile-augmented reality applications can promote distraction [ 12 ]. To our knowledge, these constitute among the first reports in the medical literature of an augmented reality application-related injury requiring acute intervention in a trauma center. We look forward to future works that can perhaps better characterize and classify the most common types of injuries that may ultimately result from increased use and adoption. We also look forward toward efforts in striking a happy balance between engagement, activity and distraction. CONFLICT OF INTEREST STATEMENT None declared. FUNDING No sources of funding for this report. CONSENT Although no photographs were taken and patients all received an anonymous trauma name on admission to the trauma center, media consent was signed. GUARANTOR Bellal Joseph, MD, first author, will serve as a guarantor. 1. Mobile cellular subscriptions (per 100 people) | Data . http:// data.worldbank.org/indicator/IT.CEL.SETS.P2 2. Tucker S , Pek S , Morrish J , Ruf M. Prevalence of texting while driving and other risky driving behaviors among young people in Ontario, Canada: evidence from 2012 and 2014 . Accid Anal Prev 2015 ; 84 : 144 - 52 . 3. Rudisill TM , Zhu M. The association between states' texting regulations and the prevalence of texting while driving among U.S. high school students . Ann Epidemiol 2015 ; 25 : 888 - 93 . 4. Parr MN , Ross LA , McManus B , Bishop HJ , Wittig SM , Stavrinos D. Differential impact of personality traits on distracted driving behaviors in teens and older adults . Accid Anal Prev 2016 ; 92 : 107 - 12 . 5. Joseph B , Haider A , Hassan A , Kulvatunyou N , Bains S , Tang A , et al. Injury prevention programs against distracted driving among students . J Trauma Acute Care Surg 2016 ; 81 : 144 - 8 . 6. Dillet R . Apple says Pokémon Go is the most downloaded app in a first week ever . TechCrunch ( 2016 ). http://social. techcrunch.com/ 2016 /07/22/apple-says -pokemon-go-is-themost-downloaded-app-in-its-first-week-ever/ 7. Tabak M , Dekker-van Weering M , van Dijk H , VollenbroekHutten M. Promoting daily physical activity by means of mobile gaming: a review of the state of the art . Games Health J 2015 ; 4 : 460 - 9 . 8. Najafi B , Armstrong DG , Mohler J . Novel wearable technology for assessing spontaneous daily physical activity and risk of falling in older adults with diabetes . J Diabetes Sci Technol 2013 ; 7 : 1147 - 60 . 9. Grewal GS , Sayeed R , Schwenk M , Bharara M , Menzies R , Talal TK , et al. Balance rehabilitation: promoting the role of virtual reality in patients with diabetic peripheral neuropathy . J Am Podiatr Med Assoc 2013 ; 103 : 498 - 507 . 10. Armstrong DG , Rankin TM , Giovinco NA , Mills JL , Matsuoka Y. A heads-up display for diabetic limb salvage surgery: a view through the google looking glass . J Diabetes Sci Technol 2014 . 10 . 1177/1932296814535561. 11. Falbe J , Willett WC , Rosner B , Field AE . Body mass index, new modes of TV viewing and active video games . Pediatr Obes 2016 . 10 .1111/ijpo.12158. 12. American College of Emergency Physicians (ACEP). Participation in activities while distracted by mobile device use . Policy statement. Ann Emerg Med 2014 ; 64 : 563 .


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Joseph, Bellal, Armstrong, David G.. Potential perils of peri-Pokémon perambulation: the dark reality of augmented reality?, Oxford Medical Case Reports, 2016, DOI: 10.1093/omcr/omw080