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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. [Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]. Med Klin Intensivmed Notfmed 2023; 118:39-46. [PMID: 37548658 DOI: 10.1007/s00063-023-01054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Alexander Krohn
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
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Shi R, Rosario J. Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review. Prehosp Disaster Med 2023; 38:645-653. [PMID: 37622570 PMCID: PMC10548023 DOI: 10.1017/s1049023x23006234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
Ultrasound with remote assistance (tele-ultrasound) may have potential to improve accessibility of ultrasound for prehospital patients. A review of recent literature on this topic has not been done before, and the feasibility of prehospital tele-ultrasound performed by non-physician personnel is unclear. In an effort to address this, the literature was qualitatively analyzed from January 1, 2010 - December 31, 2021 in the MEDLINE, EMBASE, and Cochrane online databases on prehospital, paramedic-acquired tele-ultrasound, and ten articles were found. There was considerable heterogeneity in the study design, technologies used, and the amount of ultrasound training for the paramedics, preventing cross-comparisons of different studies. Tele-ultrasound has potential to improve ultrasound accessibility by leveraging skills of a remote ultrasound expert, but there are still technological barriers to overcome before determinations on feasibility can be made.
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Affiliation(s)
- Rachel Shi
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Javier Rosario
- University of Central Florida College of Medicine, Orlando, Florida, USA
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. [Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]. DIE ANAESTHESIOLOGIE 2023; 72:654-661. [PMID: 37544933 DOI: 10.1007/s00101-023-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Alexander Krohn
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN. Notf Rett Med 2023. [DOI: 10.1007/s10049-023-01196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Naeem S, Durrands T, Christian M, Nevin D. Feasibility and impact of a bespoke pre-hospital point of care ultrasound teaching and training programme at London's air ambulance service. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:230-235. [PMID: 37538963 PMCID: PMC10395378 DOI: 10.1177/1742271x221139177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 08/05/2023]
Abstract
Introduction Point-of-care ultrasound has seen an increase in its use in pre-hospital emergency care. There is lack of literature around the training requirement for point-of-care ultrasound of pre-hospital clinicians. This service evaluation assesses the effectiveness of a bespoke hybrid teaching programme. Methods This is a service evaluation of the point-of-care ultrasound teaching programme at London's Air Ambulance from 1 April to 28 May 2021. Subjects' knowledge, image interpretation and confidence were assessed at two different points. Data were gathered using REDCap and exported to Excel for analysis. Mean values and delta were calculated, and t-test was applied for statistical significance. Results In total, 57 participants were included; out of which 11 were excluded, as they did not complete a post-course survey. Of these, 41.3% participants were point-of-care ultrasound naïve. Mean pre- and post-course scores were 76.5% and 81.7%, respectively, with an average delta improvement of 5.2% (95% confidence interval = 4.70%-5.68%) which was statistically significant (p < 0.002). There was a statistically significant mean improvement of pre- and post-course scores between point-of-care ultrasound naïve and point-of-care ultrasound experienced groups (p = 0.014). Confidence in using point-of-care ultrasound showed mean overall improvement from 2.36/4 to 3.34/4, a mean difference of 0.98 (95% confidence interval = 0.61-1.34), which was statistically significant (p = 0.0039). Conclusion Our service evaluation highlighted that a hybrid teaching model used by London's Air Ambulance was feasible and had shown significant improvement in the knowledge, image interpretation and confidence of both the point-of-care ultrasound naïve and the PoCUS experienced cohort of clinicians.
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Affiliation(s)
- Salman Naeem
- Physician Response Unit, London’s Air Ambulance, London, UK
| | | | | | - Daniel Nevin
- Pre-Hospital Care, London’s Air Ambulance, London, UK
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN. NOTARZT 2023; 39:195-203. [DOI: 10.1055/a-2114-7667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
ZusammenfassungDie Point-of-Care-Sonografie ist in der Akut- und Notfallmedizin ein fester Bestandteil der Diagnostik und Therapieeinleitung von kritisch kranken und verletzten Patienten. Während die
Notfallsonografie im Rahmen der Zusatzweiterbildung für klinische Akut- und Notfallmedizin vorausgesetzt wird, wird diese für die prähospitale Notfallmedizin lediglich im (Muster-)Kursbuch
Allgemeine und spezielle Notfallbehandlung als Weiterbildungsinhalt definiert. Obwohl einige Fachgesellschaften in Deutschland bereits eigene Lernkonzepte für die Notfallsonografie etabliert
haben, fehlt bis dato ein einheitliches nationales Ausbildungskonzept für den Einsatz der Notfallsonografie im prähospitalem Umfeld. Experten mehrerer Fachgesellschaften haben daher als
Empfehlung für die notfallmedizinische Weiterbildung ein Kurskonzept für die spezielle Ausbildung in der prähospitalen Notfallsonografie erarbeitet, welche gleichermaßen zu deren
Qualitätssicherung beitragen soll.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
- gleichberechtigte Erstautoren
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
- gleichberechtigte Erstautoren
| | - Alexander Krohn
- Department für interdisziplinäre Akut-, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut-, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité – Universitätsmedizin Berlin
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F. Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
- gleichberechtigte Letztautoren
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
- gleichberechtigte Letztautoren
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von Foerster N, Radomski MA, Martin-Gill C. Prehospital Ultrasound: A Narrative Review. PREHOSP EMERG CARE 2022; 28:1-13. [PMID: 36194192 DOI: 10.1080/10903127.2022.2132332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022]
Abstract
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.
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Affiliation(s)
- Nicholas von Foerster
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marek A Radomski
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Lucas B, Meng M, Schirrmeister W, Pliske G, Walcher F, Schüttrumpf JP. Lessons learned during the sliding gantry CT implementation in a trauma suite. Eur J Trauma Emerg Surg 2022:10.1007/s00068-022-02080-0. [PMID: 35988107 DOI: 10.1007/s00068-022-02080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Early detection of bleeding is important for managing trauma cases in the emergency department (ED). Several trauma suites are equipped with computed tomography (CT) scanners to reduce the time to CT. In the last decade, sliding gantry CT has been implemented in trauma suites, highlighting conventional techniques' advantages. We investigated the change in the time to CT and the challenges faced during the implementation. METHODS Trauma suite treatments with a conventional CT scanner between January and December 2016 formed the control group. From January to April 2017, trauma suites were modified, and treatment was outsourced to an interim trauma suite. By May 2017, trauma suites were equipped with a sliding gantry CT scanner. Treatments from May to July 2017 formed the transition group, and those from August to December 2017 formed the routine use group. We evaluated the time to CT in all groups and considered the reasons for the delays in the transition and routine use groups. RESULTS On sliding gantry CT implementation, although time to CT remained unaffected in the transition group, it significantly reduced in the routine use group, independent of injury severity score. The incidence of cable management problems was significantly higher in the latter group. CONCLUSIONS We have demonstrated a decrease in the time to CT with the implementation of a sliding gantry CT. However, due to a higher number of cable management problems in the routine use group, we recommend regular refresher team training with routine use.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Matthias Meng
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Jan Philipp Schüttrumpf
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Lucas B, Hempel D, Otto R, Brenner F, Stier M, Marzi I, Breitkreutz R, Walcher F. Prehospital FAST reduces time to admission and operative treatment: a prospective, randomized, multicenter trial. Eur J Trauma Emerg Surg 2022; 48:2701-2708. [PMID: 34661691 PMCID: PMC9360060 DOI: 10.1007/s00068-021-01806-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The focused assessment with sonography in trauma (FAST) exam is an established trauma care diagnostic procedure. Ultrasound performed during prehospital care can improve early treatment and management of the patients. In this prospective randomized clinical trial, we wanted to assess whether a pre-hospital FAST (p-FAST) influences pre-hospital strategy and the time to operative treatment. METHODS We studied 296 trauma victims in a prehospital setting. Inclusion criteria were potential abdominal injuries identified either by clinical examination or suggested by the mechanism of injury. Physician-staffed helicopters and emergency ambulances were equipped with portable ultrasound devices. According to a scheme related to calendar weeks, a clinical exam only (CEX) or a clinical exam together with a p-FAST (CEX-p-FAST) was conducted. Outcome variables were prehospital diagnosis and strategy, the time to admission to the trauma room and to operation theater. The study was approved by the university ethical committee (REB#: 46/06). RESULTS CEX-p-FAST showed a high sensitivity (94.7%) and specificity (97.6%) in detection of free fluid compared to CEX-only (80.0%, 84.4%). The median time to admission was reduced significantly by 13 min and to operative treatment by 15 min after CEX-p-FAST. We observed a cross-over rate of 30.8% of p-FAST (n = 36) to CEX-p-FAST during the CEX-only weeks. CONCLUSION According to the experience of the principal investigators, CEX-p-FAST was superior to CEX-only. Despite the time needed for p-FAST, the relevant admission time was significantly shorter. Thus, p-FAST is recommended in addition to CEX if possible for decision-making in prehospital trauma care. TRIAL REGISTRATION German Clinical Trials Register #DRKS00022117-Registered 10 July 2020-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022117 .
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Dorothea Hempel
- Central Emergency with Admission Ward, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Emergency Department, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22043, Hamburg, Germany
| | - Ronny Otto
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Franziska Brenner
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
- Department of Hand Surgery, Agaplesion Diakonieklinikum Hamburg Gemeinnützige GmbH, Hamburg, Germany
| | - Mario Stier
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Raoul Breitkreutz
- Institute for Health and Social (IfGS), FOM University of Economy and Management, Frankfurt Campus, Frankfurt, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Trauma Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Hermann M, Hafner C, Scharner V, Hribersek M, Maleczek M, Schmid A, Schaden E, Willschke H, Hamp T. Remote real-time supervision of prehospital point-of-care ultrasound: a feasibility study. Scand J Trauma Resusc Emerg Med 2022; 30:23. [PMID: 35331304 PMCID: PMC8944068 DOI: 10.1186/s13049-021-00985-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although prehospital point-of-care ultrasound (POCUS) is gaining in importance, its rapid interpretation remains challenging in prehospital emergency situations. The technical development of remote real-time supervision potentially offers the possibility to support emergency medicine providers during prehospital emergency ultrasound. The aim of this study was to assess the feasibility of live data transmission and supervision of prehospital POCUS in an urban environment and so to improve patients’ safety. Methods Emergency doctors with moderate ultrasound experience performed prehospital POCUS in emergency cases (n = 24) such as trauma, acute dyspnea or cardiac shock using the portable ultrasound device Lumify™. The ultrasound examination was remotely transmitted to an emergency ultrasound expert in the clinic for real-time supervision via a secure video and audio connection. Technical feasibility as well as quality of communication and live stream were analysed. Results Prehospital POCUS with remote real-time supervision was successfully performed in 17 patients (71%). In 3 cases, the expert was not available on time and in 1 case remote data transmission was not possible due to connection problems. In 3 cases tele-supervision was restricted to video only and no verbal communication was possible via the device itself due to power saving mode of the tablet. Conclusion Remote real-time supervision of prehospital POCUS in an urban environment is feasible most of the time with excellent image and communication quality. Trial registration: ClinicalTrials Number NCT04612816. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00985-0.
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Affiliation(s)
- Martina Hermann
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Christina Hafner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Vincenz Scharner
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Mojca Hribersek
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Mathias Maleczek
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Andreas Schmid
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Schaden
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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11
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Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model. CAN J EMERG MED 2021; 22:S62-S66. [PMID: 33084554 DOI: 10.1017/cem.2019.495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session. METHODS The interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05. RESULTS Fourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were mostly ultrasound-naive whereas the emergency physicians all had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups with accuracy of 85.6% and 87.5% (∆1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively. CONCLUSIONS This study determined that critical care paramedics were able to use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of prehospital ultrasound to aid in the triage and transport decisions of trauma patients while limiting the financial and logistical burden of ultrasound training.
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12
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Buaprasert P, Sri-On J, Sukhuntee J, Asawajaroenkul R, Buanhong O, Khiaodee T, Keetawattananon W, Tiyawat G. Diagnostic Accuracy of Extended Focused Assessment with Sonography for Trauma Performed by Paramedic Students: A Simulation-Based Pilot Study. Open Access Emerg Med 2021; 13:249-256. [PMID: 34188560 PMCID: PMC8232846 DOI: 10.2147/oaem.s311376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Training on how to perform a prehospital extended focused assessment with sonography in trauma (EFAST) has resulted in improved outcomes for trauma patients in several countries. The result of previous studies showed good accuracy despite minimal training. However, data on the diagnostic accuracy among untrained paramedic students and the course length in middle-income countries is scarce. In Thailand, the current paramedic education does not include training on prehospital ultrasounds. In the present study, we aimed to investigate the diagnostic accuracy of EFAST among ultrasound-naïve paramedic students and factors that are associated with successful posttest training. Methods Final-year paramedic students attending a 4-year university program were included in this study. A 2-h didactic training session and 1-h hands-on workshop were led by experienced emergency physicians. The diagnostic indices for EFAST interpretation were obtained pretraining and posttraining. The participants' ultrasound image acquisition was also evaluated individually on a mannequin model using a standardized assessment tool. Results In total, 47 paramedic students were voluntarily enrolled and underwent EFAST training. Of these participants, 31 (66%) reported having >1 year of experience in the prehospital field. Four were advanced emergency medical technicians before becoming paramedic students. The sensitivity, specificity, positive predictive value, and negative predictive value after training were 85.7% (95% CI, 81.5-89.3), 81.6% (95% CI, 74.2-87.6), 91.6% (95% CI, 87.9-94.4), and 71% (95% CI, 63.3-77.8), respectively. Previous prehospital experience was not associated with accuracy. Conclusion This study demonstrated that paramedic students in Thailand were able to achieve a competency comparable with that of other medical professionals in a simulated environment. The total 3 h training course was sufficient for them to acquire EFAST skills.
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Affiliation(s)
- Phudit Buaprasert
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jiraporn Sri-On
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jareeda Sukhuntee
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Ranu Asawajaroenkul
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Onchuda Buanhong
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Trairat Khiaodee
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Worrapat Keetawattananon
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Gawin Tiyawat
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
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Kalkwarf KJ, Goodman MD, Press GM, Wade CE, Cotton BA. Prehospital ABC Score Accurately Forecasts Patients Who Will Require Immediate Resource Utilization. South Med J 2021; 114:193-198. [PMID: 33787930 DOI: 10.14423/smj.0000000000001236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Scoring systems, such as the Assessment of Blood Consumption (ABC) Score, are used to identify patients at risk for massive transfusion (MT, ≥10 U red blood cells in 24 hours). Our aeromedical transport helicopter uses ultrasound to perform the Focused Assessment with Sonography for Trauma (FAST) examination. Our objective was to evaluate the ability of the Prehospital ABC (PhABC) Score to predict blood transfusions and the need for emergent laparotomy. METHODS Post hoc analysis of a prospective observational study of trauma patients who underwent an in-flight FAST during aeromedical transport during a 7-month period. PhABC Score was positive if ≥2 of the following were present in flight: penetrating trauma, heart rate >120 bpm, systolic blood pressure <90 mm Hg, or a positive abdominal FAST. The PhABC Score was evaluated by area under the receiver operating characteristic (AUROC) curves and logistic regression. RESULTS A total of 291 trauma patients met inclusion criteria, 23 underwent emergent laparotomy, and 12 received an MT. A positive PhABC Score predicted emergent laparotomy, with a positive predictive value of 48% and a negative predictive value of 95% (sensitivity 46%, specificity 96%, AUROC curve 0.83). A positive PhABC Score also predicted receipt of an MT with a positive predictive value of 28% and a negative predictive value of 94% (sensitivity 33%, specificity 93%, AUROC curve 0.77). Multiple logistic regression identified FAST as the most powerful contributor of the PhABC Score to the prediction of both emergent laparotomy (odds ratio 8.5, P < 0.001) and MT (odds ratio 5.9, P < 0.001). CONCLUSIONS The PhABC Score effectively predicts in-hospital resource utilization. It provides an outstanding undertriage rate from the prehospital setting, and it is helpful to improve trauma team activation, mobilize blood products, and prepare the operating room.
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Affiliation(s)
- Kyle J Kalkwarf
- From the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, the Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, the Department of Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, and the Center for Translational Injury Research and the Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Michael D Goodman
- From the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, the Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, the Department of Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, and the Center for Translational Injury Research and the Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Gregory M Press
- From the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, the Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, the Department of Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, and the Center for Translational Injury Research and the Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Charles E Wade
- From the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, the Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, the Department of Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, and the Center for Translational Injury Research and the Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston
| | - Bryan A Cotton
- From the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, the Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, the Department of Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, and the Center for Translational Injury Research and the Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston
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14
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Monti JD, Perreault MD. Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics. Mil Med 2020; 185:e601-e608. [PMID: 32060506 DOI: 10.1093/milmed/usaa014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Advances in the portability of ultrasound have allowed it to be increasingly employed at the point of care in austere settings. Battlefield constraints often limit the availability of medical officers throughout the operational environment, leading to increased interest in whether highly portable ultrasound devices can be employed by military medics to enhance their provision of combat casualty care. Data evaluating optimal training for effective medic employment of ultrasound is limited however. This prospective observational cohort study's primary objective was to assess the impact of a 4-hour introductory training intervention on ultrasound-naïve military medic participants' knowledge/performance of the eFAST application. MATERIALS AND METHODS Conventional U.S. Army Medics, all naïve to ultrasound, were recruited from across JBLM. Volunteer participants underwent baseline eFAST knowledge assessment via a 50-question multiple-choice exam. Participants were then randomized to receive either conventional, expert-led classroom didactic training or didactic training via an online, asynchronously available platform. All participants then underwent expert-led, small group hands-on training and practice. Participants' eFAST performance was then assessed with both live and phantom models, followed by a post-course knowledge exam. Concurrently, emergency medicine (EM) resident physician volunteers, serving as standard criterion for trained personnel, underwent the same OSCE assessments, followed by a written exam to assess their baseline eFAST knowledge. Primary outcome measures included (1) post-course knowledge improvement, (2) eFAST exam technical adequacy, and (3) eFAST exam OSCE score. Secondary outcome measures were time to exam completion and diagnostic accuracy rate for hemoperitoneum and hemopericardium. These outcome measures were then compared across medic cohorts and to those of the EM resident physician cohort. RESULTS A total of 34 medics completed the study. After 4 hours of ultrasound training, overall eFAST knowledge among the 34 medics improved from a baseline mean of 27% on the pretest to 83% post-test. For eFAST exam performance, the medics scored an average of 20.8 out of a maximum of 22 points on the OSCE. There were no statistically significant differences between the medics who received asynchronous learning versus traditional classroom-based learning, and the medics demonstrated comparable performance to previously trained EM resident physicians. CONCLUSIONS A 4-hour introductory eFAST training intervention can effectively train conventional military medics to perform the eFAST exam. Online, asynchronously available platforms may effectively mitigate some of the resource requirement burden associated with point-of-care ultrasound training. Future studies evaluating medic eFAST performance on real-world battlefield trauma patients are needed. Skill and knowledge retention must also be assessed for this degradable skill to determine frequency of refresher training when not regularly performed.
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Affiliation(s)
- Jonathan D Monti
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Washington 98431
| | - Michael D Perreault
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Washington 98431
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15
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Guy A, Bryson A, Wheeler S, McLean N, Kanji HD. A Blended Prehospital Ultrasound Curriculum for Critical Care Paramedics. Air Med J 2019; 38:426-430. [PMID: 31843154 DOI: 10.1016/j.amj.2019.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/24/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Point-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. METHODS We 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. RESULTS Seventeen 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. CONCLUSION The 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.
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Affiliation(s)
- Andrew Guy
- University of British Columbia Royal College of Physicians and Surgeons Emergency Medicine Residency Program, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony Bryson
- University of British Columbia Royal College of Physicians and Surgeons Emergency Medicine Residency Program, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Wheeler
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Ambulance Service, British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - Neilson McLean
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Critical Care, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Ambulance Service, British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - Hussein D Kanji
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Critical Care, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Ambulance Service, British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
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16
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Swamy V, Brainin P, Biering-Sørensen T, Platz E. Ability of non-physicians to perform and interpret lung ultrasound: A systematic review. Eur J Cardiovasc Nurs 2019; 18:474-483. [PMID: 31018658 DOI: 10.1177/1474515119845972] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. AIMS To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. METHODS AND RESULTS We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0-12 h of didactic training and 58-62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79-98% and a specificity of 70-99%. In image adequacy studies, medical students with 2-9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50-100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. CONCLUSIONS Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.
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Affiliation(s)
- Varsha Swamy
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Philip Brainin
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Tor Biering-Sørensen
- 2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Elke Platz
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,3 Harvard Medical School, Boston, USA
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Menegozzo CAM, Cazolari PG, da Costa Ferreira Novo F, Colleoni R, Utiyama EM. Prospective Analysis of Short- and Mid-term Knowledge Retention after a Brief Ultrasound Course for Undergraduate Medical Students. Clinics (Sao Paulo) 2019; 74:e1087. [PMID: 31531568 PMCID: PMC6735275 DOI: 10.6061/clinics/2019/e1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/05/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The benefits of implementing point-of-care ultrasound (POCUS) in the emergency department are well established. Ideally, physicians should be taught POCUS during medical school. Several different courses have been designed for that purpose and have yielded good results. However, medical students need specifically designed courses that address the main objectives of knowledge acquisition and retention. Despite that, there is limited evidence to support knowledge retention, especially in the mid-term. The purpose of this study is to evaluate short- and mid-term knowledge retention after a student-aimed ultrasound course. METHODS Medical students participating in a medical student trauma symposium (SIMPALT) in 2017 were included. Their profiles and baseline ultrasound knowledge were assessed by a precourse questionnaire (PRT). The same questionnaire was used one week (1POT) and three months (3POT) after the course. RESULTS Most of the participants were 1st- to 4th- year medical students. None had prior ultrasound knowledge. They reported costs as the major barrier (65%) to enrollment in an ultrasound course. A comparison between the PRT and 1POT results showed a statistically significant difference (p<0.02), while no difference was found between 1POT and 3POT (p>0.09). CONCLUSION Our findings support the use of a tailored ultrasound course for medical students. Knowledge acquisition and mid-term retention may be achieved by this specific population.
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Affiliation(s)
- Carlos Augusto M Menegozzo
- Disciplina de Cirurgia Geral e Trauma, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mails: /
| | | | - Fernando da Costa Ferreira Novo
- Disciplina de Cirurgia Geral e Trauma, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ramiro Colleoni
- Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Edivaldo Massazo Utiyama
- Disciplina de Cirurgia Geral e Trauma, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Scharonow M, Weilbach C. Prehospital point-of-care emergency ultrasound: a cohort study. Scand J Trauma Resusc Emerg Med 2018; 26:49. [PMID: 29914554 PMCID: PMC6006664 DOI: 10.1186/s13049-018-0519-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background In 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. Methods In 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. Results A 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. Conclusions Emergency 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.
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Affiliation(s)
- Maximilian Scharonow
- Department of Anaesthesia, Intensive Care, Emergency Medicine and Pain Therapy, St.Josefs-Hospital Cloppenburg, Krankenhausstrasse 13, 49661, Cloppenburg, Germany
| | - Christian Weilbach
- Department of Anaesthesia, Intensive Care, Emergency Medicine and Pain Therapy, St.Josefs-Hospital Cloppenburg, Krankenhausstrasse 13, 49661, Cloppenburg, Germany.
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Workman A, Hecht C, Crawford C, Sewell B, Rippy W, Palla D, Yamada R, Duane TM, Gandhi RR. Can Firefighters be Taught Ultrasound? Am Surg 2018. [DOI: 10.1177/000313481808400606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ashleigh Workman
- The University of North Texas Health Science Center Texas College of Osteopathic Medicine Fort Worth, Texas
| | - Carrie Hecht
- John Peter Smith Health Network Fort Worth, Texas
| | | | | | | | | | - Roy Yamada
- Emergency Medical Services Hurst Fire Rescue Hurst, Texas
| | - Therese M. Duane
- University of North Texas Fort Worth, Texas Department of Surgery for Quality and Safety John Peter Smith Hospital Fort Worth, Texas Acute Care Surgery Research John Peter Smith Hospital Fort Worth, Texas
| | - Rajesh R. Gandhi
- Department of Trauma John Peter Smith Hospital Fort Worth, Texas University of North Texas Fort Worth, Texas
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Morchel H, Ogedegbe C, Chaplin W, Cheney B, Zakharchenko S, Misch D, Schwartz M, Feldman J, Kaul S. Evaluation of a Novel Wireless Transmission System for Trauma Ultrasound Examinations From Moving Ambulances. Mil Med 2018; 183:111-118. [PMID: 29635573 DOI: 10.1093/milmed/usx167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/23/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To determine if physicians trained in ultrasound interpretation perceive a difference in image quality and usefulness between Extended Focused Assessment with Sonography ultrasound examinations performed at bedside in a hospital vs. by emergency medical technicians minimally trained in medical ultrasound on a moving ambulance and transmitted to the hospital via a novel wireless system. In particular, we sought to demonstrate that useful images could be obtained from patients in less than optimal imaging conditions; that is, while they were in transport. Methods Emergency medical technicians performed the examinations during transport of blunt trauma patients. Upon patient arrival at the hospital, a bedside Extended Focused Assessment with Sonography examination was performed by a physician. Both examinations were recorded and later reviewed by physicians trained in ultrasound interpretation. Results Data were collected on 20 blunt trauma patients over a period of 13 mo. Twenty ultrasound-trained physicians blindly compared transmitted vs. bedside images using 11 Questionnaire for User Interaction Satisfaction scales. Four paired samples t-tests were conducted to assess mean differences between ratings for ambulatory and base images. Conclusion Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images.
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Affiliation(s)
- Herman Morchel
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Chinwe Ogedegbe
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - William Chaplin
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Brianna Cheney
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Svetlana Zakharchenko
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - David Misch
- School of Medicine, St. George's University, University Centre, Grenada, West Indies
| | - Matthew Schwartz
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Joseph Feldman
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Sanjeev Kaul
- Trauma and Injury Prevention, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
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McCallum J, Vu E, Sweet D, Kanji HD. Assessment of Paramedic Ultrasound Curricula: A Systematic Review. Air Med J 2016; 34:360-8. [PMID: 26611224 DOI: 10.1016/j.amj.2015.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/10/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Prehospital ultrasound is being applied in the field. The purpose of this systematic review is to describe evidence pertaining to ultrasound curricula for paramedics specifically, including content, duration, setting, design, evaluation, and application. METHODS Electronic searches of MEDLINE, Embase, CINAHL, and the Cochrane Center Register of Controlled Trials were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary literature describing acute care ultrasound curricula for paramedics were included. Two authors independently extracted data and assessed quality using 2 validated tools. RESULTS Twelve studies with 187 paramedics were included. Curricula duration varied, with effective curricula teaching focused assessment with sonography for trauma (FAST) in 6 to 8 hours and pleural ultrasound in 25 minutes. FAST, pleural, and fracture-detection ultrasound are being applied in the field by paramedics; however, no literature exists describing application to detect cardiac standstill. Curricula combined didactic and hands-on components including simulation and evaluated competency using sensitivity and specificity of paramedic-performed ultrasound. CONCLUSIONS Paramedic ultrasound curricula in FAST and pleural ultrasound is feasible and time effective with successful application. Although fracture detection ultrasound is being used by the special operations forces, no comprehensive curriculum was described. Curricula designed to detect cardiac standstill have been too short, and successful application by paramedics has not been shown.
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Affiliation(s)
- Jessica McCallum
- Student, University of British Columbia MD Undergraduate Program, Vancouver, BC, Canada
| | - Erik Vu
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Emergency Health Services, Provincial AirEvac & Critical Care Operations, Vancouver, BC, Canada; Division of Critical Care, University of British Columbia, Vancouver, BC, Canada
| | - David Sweet
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Critical Care, University of British Columbia, Vancouver, BC, Canada
| | - Hussein D Kanji
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Critical Care, University of British Columbia, Vancouver, BC, Canada
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22
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[Introduction of Prehospital Emergency Ultrasound into an Emergency Medical Service Area]. Anaesthesist 2016; 66:21-27. [PMID: 27942784 DOI: 10.1007/s00101-016-0248-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/11/2016] [Accepted: 11/14/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Emergency ultrasound as part of the provision of emergency medical services using mobile devices offers great benefits regarding to some important questions related to the management of critically ill and injured patients in the prehospital situation where diagnostic resources are limited. The aim of this study is to determine whether the comprehensive introduction of prehospital emergency ultrasound examinations into a German Emergency Medical Services ("rescue services") area is both feasible and beneficial for patients. METHODS All emergency physicians at a rural emergency physician base were trained in emergency ultrasound scanning techniques (FAST, FEEL, 14 h of instruction), followed by regular weekly training sessions of approximately 30 min. Over a period of 12 months, prehospital ultrasound examinations performed during emergency physician callouts at this base were documented and analysed. RESULTS A total of 87 emergency ultrasound examinations were performed during 1343 callouts. Among these, focussed assessment with sonography for trauma (FAST) was performed in 35 patients (40.2%) and focused echocardiography in emergency life support (FEEL) in 41 patients (47.1%). In 11 patients (12.6%), ultrasound scans were performed for other indications (e. g. to rule out urinary tract obstruction in a case of flank pain). One trauma patient's life was saved by the decision to transport him to the nearest hospital and once there directly to the operating room, based on the ultrasound finding of significant free intra-abdominal fluid (ruptured spleen and liver). CONCLUSION Prehospital emergency ultrasound can be introduced into an emergency medical service area as a diagnostic modality that provides benefits to patients. Emergency physicians have to be specifically trained and to participate in continuous education activities. Especially in rural areas with longer transport routes and journey times, the early diagnosis of for example massive intra-abdominal bleeding is critical for the patient's prognosis.
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Krogh CL, Steinmetz J, Rudolph SS, Hesselfeldt R, Lippert FK, Berlac PA, Rasmussen LS. Effect of ultrasound training of physicians working in the prehospital setting. Scand J Trauma Resusc Emerg Med 2016; 24:99. [PMID: 27491760 PMCID: PMC4973524 DOI: 10.1186/s13049-016-0289-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/26/2016] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Advances in technology have made ultrasound (US) devices smaller and portable, hence accessible for prehospital care providers. This study aims to evaluate the effect of a four-hour, hands-on US training course for physicians working in the prehospital setting. The primary outcome measure was US performance assessed by the total score in a modified version of the Objective Structured Assessment of Ultrasound Skills scale (mOSAUS). METHODS Prehospital physicians participated in a four-hour US course consisting of both hands-on training and e-learning including a pre- and a post-learning test. Prior to the hands-on training a pre-training test was applied comprising of five videos in which the participants should identify pathology and a five-minute US examination of a healthy volunteer portraying to be a shocked patient after a blunt torso trauma. Following the pre-training test, the participants received a four-hour, hands-on US training course which was concluded with a post-training test. The US examinations and screen output from the US equipment were recorded for subsequent assessment. Two blinded raters assessed the videos using the mOSAUS. RESULTS Forty participants completed the study. A significant improvement was identified in e-learning performance and US performance, (37.5 (SD: 10.0)) vs. (51.3 (SD: 5.9) p = < 0.0001), total US performance score (15.3 (IQR: 12.0-17.5) vs. 17.5 (IQR: 14.5-21.0), p = < 0.0001) and in each of the five assessment elements of the mOSAUS. CONCLUSION In the prehospital physicians assessed, we found significant improvements in the ability to perform US examinations after completing a four-hour, hands-on US training course.
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Affiliation(s)
- Charlotte Loumann Krogh
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark. .,Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark. .,, Sankt Thomas Allé 13, 3 th., 1824, Frederiksberg C, Denmark.
| | - Jacob Steinmetz
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark.,Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Søren Steemann Rudolph
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark.,Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Rasmus Hesselfeldt
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark
| | - Freddy K Lippert
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Peter A Berlac
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark
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Bhat SR, Johnson DA, Pierog JE, Zaia BE, Williams SR, Gharahbaghian L. Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services. West J Emerg Med 2015; 16:503-9. [PMID: 26265961 PMCID: PMC4530907 DOI: 10.5811/westjem.2015.5.25414] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images. Methods We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties. Participants completed a pre-test of sonographic imaging of normal findings and three pathologic findings: pericardial effusion, pneumothorax, and cardiac standstill. A focused one-hour lecture on emergency US imaging followed. Post-tests were given to all EMS providers immediately following the lecture and to a subgroup one week later. Results We enrolled 57 prehospital providers (19 EMT-B students, 16 EMT-P students, 18 certified EMT-B, and 4 certified EMT-P). The mean pre-test score was 65.2%±12.7% with mean immediate post-test score of 91.1%±7.9% (95% CI [22%–30%], p<0.001). Scores significantly improved for all three pathologic findings. Nineteen subjects took the one-week post-test. Their mean score remained significantly higher: pre-test 65.8%±10.7%; immediate post-test 90.5%±7.0% (95% CI [19%–31%], p<0.001), one-week post-test 93.1%±8.3% (95% CI [21%–34%], p<0.001). Conclusion Using a small sample of EMS providers and students, this study shows the potential feasibility for educating prehospital providers to accurately identify images of pericardial effusion, pneumothorax, and cardiac standstill after a focused lecture.
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Affiliation(s)
- Sundeep R Bhat
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California ; Kaiser Permanente Santa Clara Medical Center, Department of Emergency Medicine, Santa Clara, California
| | - David A Johnson
- Emergency Medicine Physicians, Department of Emergency Medicine, Mecklenberg, North Carolina
| | - Jessica E Pierog
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Brita E Zaia
- Kaiser Permanente San Francisco Medical Center, Department of Emergency Medicine, San Francisco, California
| | - Sarah R Williams
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Laleh Gharahbaghian
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
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van Dyk S, Schneider M, Kondalsamy-Chennakesavan S, Bernshaw D, Narayan K. Ultrasound use in gynecologic brachytherapy: Time to focus the beam. Brachytherapy 2015; 14:390-400. [DOI: 10.1016/j.brachy.2014.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/22/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
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26
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Wydo SM, Seamon MJ, Melanson SW, Thomas P, Bahner DP, Stawicki SP. Portable ultrasound in disaster triage: a focused review. Eur J Trauma Emerg Surg 2015; 42:151-9. [PMID: 26038019 DOI: 10.1007/s00068-015-0498-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/04/2015] [Indexed: 12/13/2022]
Abstract
Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings.
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Affiliation(s)
- S M Wydo
- Cooper University Hospital, Camden, NJ, USA
| | - M J Seamon
- The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - S W Melanson
- St Luke's University Health Network, Bethlehem, PA, USA
| | - P Thomas
- St Luke's University Health Network, Bethlehem, PA, USA
| | - D P Bahner
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - S P Stawicki
- Department of Research and Innovation, St Luke's University Health Network, Bethlehem, PA, 18015, USA.
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28
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Duran-Gehring PE, Guirgis FW, McKee KC, Goggans S, Tran H, Kalynych CJ, Wears RL. The bubble study: ultrasound confirmation of central venous catheter placement. Am J Emerg Med 2014; 33:315-9. [PMID: 25550065 DOI: 10.1016/j.ajem.2014.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022] Open
Abstract
STUDY OBJECTIVE The objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department. METHODS The study included a convenience sample of emergency department patients with supradiaphragmatic CVCs and a CXR for confirmation. Ultrasound was used for CVC confirmation by visualizing microbubble artifact in the right atrium after injection of saline through the distal port. To evaluate for pneumothorax (PTX), "sliding sign" of the pleura was noted on US of the anterior chest. Blinded chart review was performed to assess CXR timing, catheter position and CVC complications. Student's t test was used to compare US time to CXR performance time and radiologist reading time. RESULTS Fifty patients were enrolled; 4 were excluded because of inadequate views. Forty-six patients were included in the final analysis. Mean total US time was 5.0 minutes (95% confidence interval [CI], 4.2-5.9) compared to 28.2 minutes (95% CI, 16.8-39.4) for CXR performance with a mean difference of 23.1 minutes (95% CI, -34.5 to -11.8; P < .0002). When comparing only US CVC confirmation time to CXR time, US was an average of 24.0 minutes (95% CI, -35.4 to -12.7; P < .0001) faster. Comparing total US time to radiologist CXR reading time, US was an average of 294 minutes faster (95% CI, -384.5 to -203.5; P < .0000). There were a total of 3 misplaced lines and 2 patients with PTX, all of which were identified correctly on US. CONCLUSION Ultrasound can confirm CVC placement and rule out PTX significantly faster than CXR, expediting the use of CVCs in the critically ill.
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Affiliation(s)
- Petra E Duran-Gehring
- University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
| | - Faheem W Guirgis
- University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL
| | - Kristin C McKee
- University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL
| | - Susan Goggans
- University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL
| | - Huynh Tran
- St. Mary Mercy Hospital, St. Joseph Mercy Health System, Department of Internal Medicine, Livonia, MI
| | - Colleen J Kalynych
- University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL
| | - Robert L Wears
- University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL
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Tunuka CE, Wangoda R, Bugeza S, Galukande M. Emergency sonography AIDS diagnostic accuracy of torso injuries: a study in a resource limited setting. Emerg Med Int 2014; 2014:978795. [PMID: 25114805 PMCID: PMC4119613 DOI: 10.1155/2014/978795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/27/2014] [Accepted: 06/23/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction. Clinical evaluation of patients with torso trauma is often a diagnostic challenge. Extended focused assessment with sonography for trauma (EFAST) is an emergency ultrasound scan that adds to the evaluation of intrathoracic abdominal and pericardial cavities done in FAST (focused assessment with sonography for trauma). Objective. This study compares EFAST (the index test) with the routine standard of care (SoC) investigations (the standard reference test) for torso trauma injuries. Methods. A cross-sectional descriptive study was conducted over a 3-month period. Eligible patients underwent EFAST scanning and the SoC assessment. The diagnostic accuracy of EFAST was calculated using sensitivity and specificity scores. Results. We recruited 197 patients; the M : F ratio was 5 : 1, with mean age of 27 years (SD 11). The sensitivity of EFAST was 100%, the specificity was 97%, the PPV was 87%, and the NPV was 100%. It took 5 minutes on average to complete an EFAST scan. 168 (85%) patients were EFAST-scanned. Most patients (82) (48%) were discharged on the same day of hospitalization, while 7 (4%) were still at the hospital after two weeks. The mortality rate was 18 (9%). Conclusion. EFAST is a reliable method of diagnosing torso injuries in a resource limited context.
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Affiliation(s)
- Charles Edward Tunuka
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Wangoda
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sam Bugeza
- Department of Radiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
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Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, Davidsen JR, Rasmussen F. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2014; 144:1868-1875. [PMID: 23948720 DOI: 10.1378/chest.13-0882] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute respiratory symptoms. METHODS A prospective blinded observational study was conducted in a medical ED. Inclusion criteria were the presence of one or more of the following: respiratory rate > 20/min, oxygen saturation < 95%, oxygen therapy initiated, dyspnea, cough, or chest pain. After the initial assessment, focused sonography of the heart, lungs, and deep veins was performed by a physician blinded to patient history and the results of the primary assessment. RESULTS One hundred thirty-nine patients were included. The focused sonographic examinations could be performed in 134 patients (96%). Focused sonography identified 19 patients (14%) with an acute life-threatening condition missed at the primary assessment. Diagnostic performance of focused sonography for the diagnosis of an acute life-threatening condition, when using audit as gold standard, was as follows: sensitivity, 100% (95% CI, 85.2%-100%); specificity, 93.3% (95% CI, 86.7%-97.3%); positive predictive value, 76.7% (95% CI, 57.7%-90.1%); and negative predictive value, 100% (95% CI, 96.3%-100%). CONCLUSIONS Focused sonography of the heart, lungs, and deep veins is fast, highly feasible, and able to diagnose life-threatening conditions missed at the primary assessment in admitted patients with acute respiratory symptoms. In an ED setting sonography can be used both for ruling in and ruling out acute life-threatening conditions in these patients.
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Affiliation(s)
- Christian B Laursen
- Research Unit at the Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Erik Sloth
- Department of Anesthesia and Intensive Care, Aarhus University Hospital, Skejby, Denmark
| | - Jess Lambrechtsen
- Department of Medicine, Odense University Hospital-Svendborg, Svendborg, Denmark
| | | | | | - Daniel Pilsgaard Henriksen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Finn Rasmussen
- Department of Allergy and Respiratory Medicine, Near East University Hospital, Nicosia, North Cyprus, Turkey
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Evaluation of a Training Curriculum for Prehospital Trauma Ultrasound. J Emerg Med 2013; 45:856-64. [DOI: 10.1016/j.jemermed.2013.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 02/07/2013] [Accepted: 05/01/2013] [Indexed: 11/24/2022]
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Thorax, trachea, and lung ultrasonography in emergency and critical care medicine: assessment of an objective structured training concept. Emerg Med Int 2013; 2013:312758. [PMID: 24369503 PMCID: PMC3863481 DOI: 10.1155/2013/312758] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/26/2013] [Indexed: 01/09/2023] Open
Abstract
Background and Study objective. Focused lung ultrasound (LUS) examinations are important tools in critical care medicine. There is evidence that LUS can be used for the detection of acute thoracic lesions. However, no validated training method is available. The goal of this study was to develop and assess an objective structured clinical examination (OSCE) curriculum for focused thorax, trachea, and lung ultrasound in emergency and critical care medicine (THOLUUSE). Methods. 39 trainees underwent a one-day training course in a prospective educational study, including lectures in sonoanatomy and -pathology of the thorax, case presentations, and hands-on training. Trainees' pre- and posttest performances were assessed by multiple choice questionnaires, visual perception tests by interpretation video clips, practical performance of LUS, and identification of specific ultrasound findings. Results. Trainees postcourse scores of correct MCQ answers increased from 56 ± 4% to 82 ± 2% (mean± SD; P < 0.001); visual perception skills increased from 54 ± 5% to 78 ± 3% (P < 0.001); practical ultrasound skills improved, and correct LUS was performed in 94%. Subgroup analysis revealed that learning success was independent from the trainees' previous ultrasound experience. Conclusions. THOLUUSE significantly improves theoretical and practical skills for the diagnosis of acute thoracic lesions. We propose to implement THOLUUSE in emergency medicine training.
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Trauma ultrasound in civilian tactical medicine. Emerg Med Int 2012; 2012:781570. [PMID: 23243509 PMCID: PMC3517827 DOI: 10.1155/2012/781570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/15/2012] [Indexed: 11/18/2022] Open
Abstract
The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years' literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.
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