Prehospital Ultrasound Research Articles

294 The Use of Prehospital Ultrasound: A Scoping Review

294 The Use of Prehospital Ultrasound: A Scoping Review

Implementing Prehospital Ultrasound at the Saudi Red Crescent Authority: Perceived Barriers and Training Needs.

This study examines the inherent barriers to implementing prehospital ultrasound within the Saudi Red Crescent Authority (SRCA) in Saudi Arabia. A qualitative study was conducted to explore the perceived barriers, mode of transportation, ultrasound familiarity, and self-efficacy level of relevant stakeholders in implementing the prehospital ultrasound in SRCA. Data was collected via surveys and interviews with 24 SRCA paramedics/EMTs, 4 SRCA station administrators, and two hospital physicians to further examine the inherent barriers of implementing the prehospital ultrasound. Thematic analysis revealed the main barriers were costs of ultrasound equipment, environmental factors affecting image capture, and lack of training in ultrasound skills and interpretation. Administrators and physicians also noted concerns about machine portability and technical maintenance. Stakeholders agreed ultrasound could improve trauma diagnosis if barriers were addressed through extensive training and protocols. In prehospital care setting, the two main modes of transportation are "stay and play", involving on-scene interventions before transport, and "load and go", prioritizing rapid transport to the hospital, with the choice depending on various factors. An overwhelming 96% of paramedics/EMTs preferred a 'stay and play' approach to stabilize patients before transport, while 75% of administrators preferred 'load and go' for rapid transport to hospitals. 62.5% of paramedics were familiar with ultrasound, but only 20.8% had previously used it. This study provides important insights into stakeholder perspectives on the implementation of prehospital ultrasound within the Saudi Red Crescent Authority. The findings can guide efforts to implement appropriate ultrasound use through tailored training programs and enhanced coordination across groups, aimed at improving trauma outcomes.

Rapid Ultrasonography for Shock and Hypotension Protocol Performed using Handheld Ultrasound Devices by Paramedics in a Moving Ambulance: Evaluation of Image Accuracy and Time in Motion.

Handheld ultrasound (US) devices have become increasingly popular since the early 2000s due to their portability and affordability compared to conventional devices. The Rapid Ultrasonography for Shock and Hypotension (RUSH) protocol, introduced in 2009, has shown promising accuracy rates when performed with handheld devices. However, there are limited data on the accuracy of such examinations performed in a moving ambulance. This study aimed to assess the feasibility and accuracy of the RUSH protocol performed by paramedics using handheld US devices in a moving ambulance. The study aimed to examine the performability of the RUSH protocol with handheld US devices in a moving ambulance and to evaluate the accuracy of diagnostic views obtained within an appropriate time frame. A prospective study was conducted with paramedics who underwent theoretical and practical training in the RUSH protocol. The participants performed the protocol using a handheld US device in both stationary and moving ambulances. Various cardiac and abdominal views were obtained and evaluated for accuracy. The duration of the protocol performance was recorded for each participant. Nine paramedics completed the study, with 18 performances each in both stationary and moving ambulance groups. The accuracy of diagnostic views obtained during the RUSH protocol did not significantly differ between the stationary and moving groups. However, the duration of protocol performance was significantly shorter in the moving group compared to the stationary group. Paramedics demonstrated the ability to perform the RUSH protocol effectively using handheld US devices in both stationary and moving ambulances following standard theoretical and practical training. The findings suggest that ambulance movement does not significantly affect the accuracy of diagnostic views obtained during the protocol. Further studies with larger sample sizes are warranted to validate these findings and explore the potential benefits of prehospital US in dynamic environments.

Prehospital Ultrasound: Nationwide Incidence from the NEMSIS Database

Objective We sought to describe prehospital ultrasound (PHUS) use and trends in PHUS utilization over time using a national database. Methods Using the 2018 – 2021 National Emergency Medical Services Information System databases, we identified those EMS activations where PHUS was performed. We evaluated the association between year and number of PHUS exams performed using univariable and multivariable regression analysis. Analysis was performed on the overall group and various subgroups. Results In total, there were 148,709,000 EMS activations by 13,899 agencies over the 4 years. Of these, 3,291 unique activations (0.002%) involved PHUS, performed by 71 EMS agencies (0.5%). The annual rate of ultrasound evaluations per 1 million EMS activations significantly increased over the study period: 5.2 in 2018, 14.8 in 2019, 18.6 in 2020, and 38.9 in 2021 (p < 0.01). The number of agencies performing PHUS each year increased over the study period from 11 in 2018 to 54 in 2021 (p < 0.05). Each year after 2018 had an increased odds of PHUS use demonstrated with logistic regression (p < 0.01). PHUS was used in each US census region, and paramedics performed most of the PHUS exams (75.5%). We identified 1,060 out-of-hospital cardiac arrest, 820 trauma, and 427 respiratory PHUS cases. These three cohorts accounted for 70.1% of all PHUS cases. Conclusion Prehospital ultrasound use in the United States increased significantly over the study period, but remains exceedingly rare. The performance of PHUS was recorded throughout the United States, with paramedics performing the majority of PHUS studies included in this database.

PrehospitaL Ultrasound in Undifferentiated DyspnEa (PreLUDE): a prospective, clinical, observational study

BackgroundDiagnostic uncertainty in patients with dyspnea is associated with worse outcomes. We hypothesized that prehospital point-of-care ultrasound (POCUS) can improve diagnostic accuracy.MethodsProspective observational study of adult patients suffering dyspnea. Prehospital critical care physicians registered a suspected diagnosis based on clinical examination alone, performed POCUS of the heart and lungs, and finally registered suspected diagnoses based on their clinical examination supplemented with POCUS. Pre- and post-POCUS diagnoses were compared to endpoint committee adjudicated diagnoses. The primary outcome was improved sensitivity for diagnosing acute heart failure. Secondary outcomes included other diagnostic accuracy measures in relation to acute heart failure and other causes of dyspnea.ResultsIn total, 214 patients were included. The diagnosis of acute heart failure was suspected in 64/214 (30%) of patients before POCUS and 64/214 (30%) patients after POCUS, but POCUS led to reclassification in 53/214 (25%) patients. The endpoint committee adjudicated the diagnosis of acute heart failure in 87/214 (41%) patients. The sensitivity for the diagnosis of acute heart failure was 58% (95% CI 46%–69%) before POCUS compared to 65% (95% CI 53%–75%) after POCUS (p = 0.12). ROC AUC for the diagnosis acute heart failure was 0.72 (95% CI 0.66–0.78) before POCUS compared to 0.79 (0.73–0.84) after POCUS (p < 0.001). ROC AUC for the diagnosis acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) or asthma was 0.87 (0.82–0.91) before POCUS and 0.93 (0.88–0.97) after POCUS (p < 0.001). A POCUS finding of any of severely reduced left ventricular function, bilateral B-lines or bilateral pleural effusion demonstrated the highest sensitivity for acute heart failure at 88% (95% CI 79%–94%), whereas the combination of all of these three findings yielded the highest specificity at 99% (95% CI 95%–100%).ConclusionSupplementary prehospital POCUS leads to an improvement of diagnostic accuracy of both heart failure and AE-COPD/-asthma overall described by ROC AUC, but the increase in sensitivity for the diagnoses of acute heart failure did not reach statistical significance. Tailored use of POCUS findings optimizes diagnostic accuracy for rule-out and rule-in of acute heart failure.Trial registration: Registered in Clinical Trials, 05.04.2019 (identifier: NCT03905460) https://clinicaltrials.gov/ct2/show/study/NCT03905460?term=NCT03905460&cond=Dyspnea&cntry=DK&draw=2&rank=1.

Prehospital Lung Ultrasound: Impact on Diagnosis and Management in Patients with Acute Heart Failure

Background/Objective: In the United States, one million hospitalizations occur each year due to acute heart failure (AHF), with a one-year mortality rate of 27%. Recent literature suggests that early diagnosis and treatment is associated with improved prognosis. We investigated the diagnostic accuracy of prehospital paramedic-performed lung ultrasound (LUS) and its impact on initial treatment of patients with AHF.&#x0D; Methods: Paramedics, previously trained in LUS, performed a 4-zone LUS protocol to evaluate for the presence or absence of pulmonary edema. Per protocol, presence of bilateral B-lines was diagnostic of AHF and treatment included nitroglycerin. Inclusion criteria were patients (&gt;18 years old) with shortness of breath and at least one of the following: bilateral lower extremity edema, orthopnea, wheezing or rales on auscultation, increased work of breathing, tachypnea (RR&gt;20) or hypoxia (oxygen saturation &lt;92%). Patient data was collected in the hospital setting and evaluated by 2 separate physicians to determine final diagnoses of AHF. Paramedic data were analyzed for LUS image quality, accuracy of AHF diagnosis, and prehospital treatment.&#x0D; Results: Prehospital LUS was performed on 27 patients meeting inclusion criteria. Diagnostic accuracy for AHF yielded a sensitivity of 66.7% (95% CI 29.9%-92.5%) and specificity of 100% (95% CI 81.5%-100%). Of the 9 patients with AHF, 3 were not correctly identified despite having bilateral B-lines on LUS and 3 (33%) received prehospital nitroglycerin. Median LUS image quality was 4 (range 3-5) on a 5-point scale.&#x0D; Conclusion: Paramedic performed LUS was highly specific and moderately sensitive for the diagnosis of AHF, which is an improvement over diagnostic accuracy without the use of LUS (prior literature showing 14% sensitivity, 98% specificity). LUS slightly improved prehospital initiation of HF therapy (33% vs 28% previously reported). More training is needed to improve accuracy of LUS diagnosis and increase initiation of HF therapies in the prehospital setting.

Prehospital Ultrasound: A Narrative Review

Background: Point-of-care ultrasound is rapidly becoming more prevalent in the prehospital environment. Though considered a relatively new intervention in this setting, there is growing literature that aims to explore the use of prehospital ultrasound by EMS personnel. Methods: To better understand and report the state of the science on prehospital ultrasound, we conducted a narrative review of the literature. Results: Following a keyword search of MEDLINE in Ovid from inception to August 2, 2022, 2,564 records were identified and screened. Based on review of abstracts and full texts, with addition of seven articles via bibliography review, 193 records were included. Many included studies detail usage in air medical and other critical care transport environments. Clinicians performing prehospital ultrasound are often physicians or other advanced practice personnel who have previous ultrasound experience, which facilitates implementation in the prehospital setting. Emerging literature details training programs for prehospital personnel who are novices to ultrasound, and implementation for some study types appears feasible without prior experience. Unique use scenarios that show promise include during critical care transport, for triage in austere settings, and for thoracic evaluation of patients at risk of life-threatening pathology. Conclusion: There is a growing mostly observational body of literature describing the use of ultrasound by prehospital personnel. Prehospital ultrasound has demonstrated feasibility for specific conditions, yet interventional studies evaluating benefit to patient outcomes are absent.

The Utilization of Handheld Ultrasound Devices in a Prehospital Setting.

Prehospital ultrasounds can be considered a new form of diagnostic tool when taking into account their small structure and due to the fact that nowadays, they are used in the care of emergency patients. However, at present, there is no study regarding the advantage of ultrasound usage in prehospital settings in Thailand. This study aims to determine the sonographic characteristics recorded by handheld ultrasounds used in prehospital care and the diagnostic accuracy of ultrasounds for prehospital patients. A cross-sectional study was conducted on prehospital patients who underwent point-of-care ultrasound (POCUS) examination on Emergency Medical Service (EMS) operations at Srinagarind Hospital, Thailand from January 2021 through December 2021. The ultrasound images, the electronic emergency department medical records, and the EMS database were recorded and reviewed by a team of emergency physicians. The quality of prehospital ultrasound examinations was assessed by comparing the diagnoses at the scene with those taken at the hospital. One hundred sixty-nine prehospital patients who received POCUS examinations were examined over a one-year period. All (100.0%) of the scans were for medical cases. No ultrasound protocol was used in the prehospital care. Two hundred eight POCUS examinations were performed in this study. The most common POCUS indication was dyspnea (45.6%), followed by hypotension/shock (30.1%), and finally syncope (8.2%). The most common area where POCUS was performed was on the lung (37.0%), followed by the inferior vena cava (30.8%), and finally for cardiac cases (26.4%). This study found that 34.9% of sonographic findings could be considered abnormal. The diagnoses of prehospital patients were confirmed by using POCUS in 66 cases (39.1%) with the accuracy of prehospital diagnosis reaching a peak of 75.8%. This study shows POCUS examinations can be effectively used in prehospital care. The prehospital diagnosis given by physicians administering treatment who used POCUS examinations correlated with the in-hospital diagnosis.

Overview of current implementation and limitations of point-of-care ultrasound in the emergency department: a nationwide survey in Belgium

ABSTRACT Objective Giving an overview of the current implementation and limitations of point-of-care ultrasound (POCUS) in Belgian Emergency Departments (EDs). Methods A survey, consisting of questions regarding demographics, practice patterns, policies, difficulties of implementing ultrasound (US) and training of emergency physicians was sent out to all Belgian EDs (n = 109). Results Seventy-two percent of all the EDs responded. Eighty percent of these had an US device, 10% intended to have one in the near future whilst the remaining 10% had no intention of obtaining one. The main reasons for not having US were insufficient training (50%), no budget to purchase a device (31%), resistance from other specialties (31%), no return from investment (25%) and uncertainty about liability (19%). Eighty-four percent of the responding hospitals had a prehospital MUG (Mobiele Urgentiegroep) – team or SMUR (Service Mobile d’Urgence et de Réanimation). In 29% of these, prehospital US (PHUS) was used, 18% were in the process of purchasing a device whilst 53% had no intention of implementing PHUS. The main reasons for not implementing PHUS were short transfer times (38%), insufficient training (33%), the cost of a device (25%), no return from investment (19%), the assumption that PHUS delays administering urgent care (19%) and the uncertainty about liability (8%). Nationwide, 40% of all emergency physicians have had some form of US training. Conclusions POCUS is regularly used in Belgian EDs for diagnostic and management purposes. Further implementation of POCUS will depend on how barriers are being addressed in the near future.

Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review

Background Trauma is a leading cause of death in the United States. Ultrasound use in the prehospital environment has the potential to change trauma management. Although ultrasound use for prehospital trauma is increasing, the role of this modality is not clearly defined. Objectives We examined the use of prehospital ultrasound (PHUS) for trauma patients and the use by different provider types. Specific factors of interest were if prehospital ultrasound has been shown to improve providers’ ability to recognize conditions that can be managed in the prehospital setting, treat these conditions, change transport destination, or improve overall mortality rates for trauma patients. Methods We searched MEDLINE/PubMed, EBSCOhost, Cochrane Library, and Embase medical literature databases for articles that addressed our outcomes. s and articles were examined and studies that did not specifically evaluate ultrasound in the prehospital setting for trauma and duplicates were eliminated. Studies included in this comprehensive review were assessed for the use of ultrasound in the prehospital setting to aid in the diagnosis, treatment, and transport of trauma patients. We also conducted an analysis of bias in the included articles. Due to the large heterogeneity in the included studies, no meta-analysis could be performed. Results Sixteen studies were identified comprising 3,317 patients. One study evaluated Emergency Medical Services (EMS) professionals as the ultrasound operator while five studies involved mixed practitioners and ten studies involved only physicians. Diagnostic accuracy was similar amongst physicians and mixed practitioners with no studies reporting PHUS accuracy for EMS providers alone. Seven studies evaluated treatment and transport impact of PHUS though the variables measured were inconsistent and results varied by protocol and outcomes measured. There were no studies that evaluated PHUS and its impact on patient mortality. Conclusion Ultrasound use in the prehospital setting for trauma is feasible and demonstrates potential. However, the evidence in the medical literature mainly consists of prospective observational studies of physicians utilizing ultrasound for trauma in a HEMS setting. Further scientific research must be undertaken to firmly establish the role of prehospital ultrasound in trauma management by all types of EMS providers.

In Response.

We thank Anile et al1 for their letter which expanded our concept of ultrasound (US)-guided triage for early detection of coronavirus disease 2019 (COVID-19) lung pneumonia. Moreover, we really appreciated the concept of a COVID alphabet as a multimodal approach to guide diagnosis and treatment in critical patients admitted in intensive care units (ICUs).2 Since its outbreak, COVID-19 pandemic created a never seen before connection between physicians from everywhere in the world, which resulted in sharing crucial information and data about early clinical experiences. Although many therapies have been suggested, at present, there are still no specific options capable of treating successfully severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease; by now, the only viable intervention which has proven to decrease the contagion rate seems to be preventive measures between general population, including quarantine, social distancing, and personal hygiene.3 In COVID-19 symptomatic patients, the disease stage and the extent of multiorganic involvement should be defined in order to plan the care process properly. In this regard, the COVID US alphabet could be universally spoken, across all medical specialties and the nationalities, giving accurate indications on the pathology stages and guiding clinicians through therapeutic interventions. US can graphically track the entire timeline of COVID-19 lung infection, recognizing typical signs from the initial stages to the advanced ones.4 US has a fundamental role in both prehospital and intrahospital care, but it should not be excluded as a useful application in posthospital follow-up as well. A summary of the potential role for US in both pandemic and postpandemic stages is shown in the Figure. Recent evidence, in fact, suggests possible long-term pulmonary lesions caused by COVID-19 disease.5Figure.: The evolution of US role in COVID-19 pandemic. COVID-19 indicates coronavirus disease 2019; US, ultrasound.US follow-up could be performed by clinicians with different skill sets, including general practitioners in outpatient medical settings, that is, clinics, medical offices, or even at patient’s home. Currently, the use of US has spread throughout medical disciplines, encouraged by the commercialization of portable probes, which have been proven effective in both diagnostic and interventional settings,6 and could be useful in environments beyond the ICU or the emergency department. Furthermore, a prehospital US assessment may contribute to early diagnosis in the event of a forthcoming new pandemic; US could be used as a screening test in combination with real time-polymerase chain reaction (PCR) and rapid serologic tests in patients who exhibit symptoms of respiratory tract infections. The use of US as a simple, noninvasive, and low-cost screening test for early detection of new clusters of SARS-CoV-2 contagions could be a key weapon to ward off the threat of a new world pandemic. Giuseppe Pascarella, MDAlessandro Strumia, MDUnit of Anaesthesia, Intensive Careand Pain ManagementDepartment of MedicineUniversità Campus Bio-Medico di RomaRome, ItalyMichael Benjamin Stone, MDDepartment of Emergency MedicineLegacy Emanuel Medical CenterPortland, OregonChiara Piliego, MDUnit of Anaesthesia, Intensive Careand Pain ManagementDepartment of MedicineUniversità Campus Bio-Medico di RomaRome, Italy[email protected]

A Blended Prehospital Ultrasound Curriculum for Critical Care Paramedics

ObjectivePoint-of-care ultrasound is a nascent and growing area of prehospital care. Most previously described ultrasound curricula for paramedics examine a single type of ultrasound scan. Here, we describe the implementation and evaluation of a prehospital ultrasound curriculum using a blended model of traditional didactics and hands-on experience with online prereading. MethodsWe recruited a prospective convenience sample of critical care paramedics without prior ultrasound experience to take part in a 2-day ultrasound course. All participants completed prereading modules built from online resources followed by a didactic review of the material and hands-on practice. Ultrasound examinations included extended focused abdominal sonography in trauma, cardiac ultrasound, thoracic ultrasound, and vascular ultrasound. A written examination evaluated ultrasound theory and image interpretation, and a practical examination evaluated image acquisition. ResultsSeventeen critical care paramedics completed the course with a mean grade on the written examination of 76%, with 76% of paramedics achieving the predetermined passing mark of 70% or greater. All paramedics passed the practical examination. ConclusionThe implementation of a prehospital critical care ultrasound program is feasible in our provincial emergency medical services system. Further assessment is necessary to determine future knowledge and skill retention as well as clinical application and utility in real-world settings.

Abdominal prehospital ultrasound impacts treatment decisions in a Dutch Helicopter Emergency Medical Service.

The aim of this study was to determine the impact of abdominal prehospital ultrasound (PHUS) on patient care in a Dutch physician-staffed Helicopter Emergency Medical Service (HEMS) and to determine its diagnostic performance. We carried out a retrospective analysis of abdominal ultrasound (US) examinations performed by the HEMS of Nijmegen, the Netherlands, from January 2007 until December 2016. Data including patient demographics, type of incident, abdominal US findings, impact on treatment decisions, and the physicians' narrative report were retrieved from the HEMS database and analyzed. PHUS diagnostic performance was compared with computed tomography scan or laparotomy. Of 17 077 recorded scrambles and 8699 patients treated, 1583 underwent 1631 abdominal US examinations. After eliminating missing data, 251 impacts on treatment in 194 out of 1539 PHUS examinations were identified (12.6%, 95% confidence interval: 10.9-14.3). This affected 188 out of 1495 (12.6%) patients. The four main categories of treatment decisions impacted by PHUS were information provided to the destination hospital (45.4%); mode of transportation (23.5%); choice of destination hospital (13.1%); and fluid management (11.6%). The sensitivity of prehospital abdominal US for hemoperitoneum was 31.3%, specificity was 96.7%, and accuracy was 82.1%. Abdominal PHUS in our setting impacts treatment decisions significantly. Therefore, it is a valuable tool in the Dutch HEMS setting and probably beyond.

Prehospital point-of-care emergency ultrasound: a cohort study

BackgroundIn the prehospital situation, the diagnostic armamentarium available to the rescue physician is limited. Emergency ultrasound has proven to be a useful diagnostic tool, providing crucial information for the management of critically ill and injured patients. The proportion of performed ultrasound scans in all patients attended to by the rescue service team, the quality of the findings and the ultrasound-related changes in management approach and patient transport were evaluated.MethodsIn this prospective 18-month observational study, we documented all missions performed by rescue physicians with special training in emergency ultrasound (expert standard). These data were than analysed with regard to the ultrasound examinations. The ultrasound protocols used comprised Focussed Assessment with Sonography for Trauma (FAST), Prehospital Lung Ultrasound (PLUS) and Focused Echocardiography in Emergency Life support (FEEL). The quality of prehospital examinations was assessed by comparing the findings and diagnoses at the emergency site with those established in hospital. The changes in patient management and transport were documented using a standardized protocol.ResultsA total of 99 (18.1%) emergency ultrasound examinations were performed during 546 callouts. The most common indications for prehospital emergency ultrasound were dyspnoea (n = 38; 38.4%), during cardiac arrest (n = 17/17.2%), fall (n = 12/12.1%) and high-speed trauma (n = 11/11.1%). The combinations of ultrasound examination protocols in the trauma group (n = 31; 31.3%) were: 1. FAST+FEEL+PLUS (n = 17; 54.8%). 2. FAST+PLUS (n = 11; 35.5%) 3. FAST alone (n = 3; 9.7%). In the non-trauma group (n = 68; 68.7%), the following combinations were used: 1. FEEL+PLUS (n = 36; 52.9%), 2. FEEL alone (n = 21/30.9%). 3. PLUS alone (n = 6/8.8%) 4. FAST alone (n = 2; 2.9%) 5. FAST+FEEL+PLUS (n = 2; 2.9%). 6. FAST+FEEL (n = 1/1.5%). The emergency ultrasound findings impaired left ventricular contractile function (sensitivity 89.4%), right ventricular stress (85.7%), lung interstitial syndrome (100%), ruling out pneumothorax (specificity 100%), ruling out intraabdominal fluid (97,1%) were verified at the receiving hospital using ultrasonography, CT scan or x-rays; the prehospital diagnosis was confirmed in 90.8% of cases, the difference between the prehospital and in-hospital findings were not significant(p-values from p = 0.688 to p = 0,99). Ultrasound-related changes in patient management occurred in 49.5% of patients; in 33.3%, these were transported-related.ConclusionsEmergency ultrasound was as often used in the prehospital situation as it is in hospital. The ultrasound findings correlated well with in-hospital diagnostic results. Significant pathology changed patient-management, without prolonging the mission time.

Early identification of aortic dissection with pre-hospital ultrasound: a case report

Background: Several studies have demonstrated the feasibility of pre-hospital ultrasound (US) in patients with trauma, cardiac arrest, and respiratory insufficiency. It should be rapid, problem based and the use of specific protocols (focused assessment of sonography for trauma, focused echocardiography in life support, and rapid ultrasound for shock and hypotension) prevents delays. Case Presentation: We present a case of a 50-year-old man with a syncope while he was working. When the ambulance arrived, he was hemodynamically unstable, indicated dorsal–lumbar pain, an asymmetry of the radial pulses was found, and the electrocardiography did not register any ST segment alterations. A pre-hospital US showed a dilation of the ascendant aorta and a floating flap inside the aortic arch and the abdominal aorta. The computed tomography scan confirmed a dissection from the aortic bulb to the left femoral artery and the patient was transported rapidly to the nearest heart and thoracic surgeries. Conclusion: The evaluation of the aorta should be considered a new indication of pre-hospital US.

Prehospital Ultrasound in Trauma: A Review of Current and Potential Future Clinical Applications.

Ultrasound (US) is an essential tool for evaluating trauma patients in the hospital setting. Many previous in-hospital studies have been extrapolated to out of hospital setting to improve diagnostic accuracy in prehospital and austere environments. This review article presents the role of prehospital US in blunt and penetrating trauma management with emphasis on its current clinical applications, challenges, and future implications of such use.

Pre-hospital assessment with ultrasound in emergencies: implementation in the field.

Point-of-care ultrasound (US) is a proven diagnostic imaging tool in the emergency department (ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the field and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients. We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest. Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making (89%, 95%CI 67%-99%). Paramedics accurately recorded 17 cases of cardiac activity (100%, 95%CI 84%-100%) and 2 cases of cardiac standstill (100%, 95%CI 22%-100%). Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.

Ultrasound use in Kent, Surrey and Sussex Air Ambulance: a survey

Kent Surrey and Sussex (KSS) air ambulance utilize a portable ultrasound (US) scanning machine with a high frequency linear probe. Current standard operating procedure (SOP) states it should be used as an adjunct to chest assessment. Formal indications for pre-hospital US use are not yet established despite many theoretical uses in the literature.

Is Point-of-Care Ultrasound Accurate and Useful in the Hands of Military Medical Technicians? A Review of the Literature

Over the past decade, point-of-care ultrasound (US) use by nonphysician providers has grown substantially. The purpose of this article is to (1) summarize the literature evaluating military medics' facility at US, (2) more clearly define the potential utility of military prehospital US technology, and (3) lay a pathway for future research of military prehospital US. The authors performed a keyword search using multiple search engines. Each author independently reviewed the search results and evaluated the literature for inclusion. Of 30 studies identified, five studies met inclusion criteria. The applications included evaluation of cardiac activity, pneumothorax evaluation, and fracture evaluation. Additionally, a descriptive study demonstrated distribution of US exam types during practical use by Army Special Forces Medical Sergeants. No studies evaluated retention of skills over prolonged periods. Multiple studies demonstrate the feasibility of training military medics in US. Even under austere conditions, the majority of studies conclude that medic can perform US with a high degree of accuracy. Lessons learned from these studies tend to support continued use of US in out-of-hospital settings and exploration of the optimal curriculum to introduce this skill.

Does prehospital ultrasound improve treatment of the trauma patient? A systematic review

Ultrasound (US) has been used for in-hospital evaluation of the trauma victim for many years. The outcome in severely injured patients remains heavily influenced by initial life support and early care, as time plays a major role. Development of handheld, battery-powered, low-weight US machines has created the possibility of bringing US to the prehospital setting, thus gaining a potential for early diagnosis and treatment. The objective of this study was to systematically search the literature for evidence that prehospital US of the abdomen or thorax increases survival of trauma patients. The data regarding the use of US in the prehospital setting is sparse, often of low quality and describing a broad variety of patients and clinical challenges. Therefore, from an evidence point of view it is not possible to answer the objectives in this review. In the prehospital setting, rapid assessment plays an important role, as initial life support and early surgical care influences the outcome of the severely injured patient. Time is especially crucial in blunt abdominal trauma and penetrating truncal injuries. Several studies in this review showed that prehospital US is feasible and that the procedure is highly reliable in detection of haemoperitoneum or haemopericardium compared with the low accuracy of physical examination and haemodynamic measurements. An early diagnosis will provide the prehospital physician with the knowledge to prioritize the relevant initial treatment and to choose the closest appropriate hospital and transportation form. There is currently no evidence in the literature that prehospital US of the abdomen or thorax improves treatment of trauma patients.