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Alsulami M, Almukhlifi Y, Alsulami A, Al Nufaiei ZF, Alruwaili A, Alanazy A. Implementing Prehospital Ultrasound at the Saudi Red Crescent Authority: Perceived Barriers and Training Needs. J Multidiscip Healthc 2024; 17:2871-2878. [PMID: 38881755 PMCID: PMC11180463 DOI: 10.2147/jmdh.s457429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This study examines the inherent barriers to implementing prehospital ultrasound within the Saudi Red Crescent Authority (SRCA) in Saudi Arabia. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Maher Alsulami
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Educational Leadership Program, School of Education, Duquesne University, Pittsburgh, PA, USA
| | - Yasir Almukhlifi
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Adnan Alsulami
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ziyad F Al Nufaiei
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah Alruwaili
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Al-Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al-Ahsa, Saudi Arabia
| | - Ahmed Alanazy
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Al-Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al-Ahsa, Saudi Arabia
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Haines CM, Waasdorp CP, Lockhart ER, Lareau SA. Point-of-Care Ultrasound Transmission for Remote Interpretation in Austere Environments. Wilderness Environ Med 2023; 34:420-426. [PMID: 37391353 DOI: 10.1016/j.wem.2023.05.009] [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: 07/03/2022] [Revised: 04/24/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is used in wilderness medicine and could potentially be the only imaging modality available. Cellular and data coverage is often lacking in remote areas, limiting image transmission. This study evaluates the viability of transmitting POCUS images from austere environments using slow-scan television (SSTV) image transmission methods over very-high-frequency (VHF) hand-held radio units for remote interpretation. METHODS Fifteen deidentified POCUS images were selected and encoded into an SSTV audio stream by a smartphone and transmitted over a VHF radio. A second radio and smartphone 1 to 5 mi away received and decoded the signals back into images. The original images and transmitted images were randomized into a survey graded by emergency medicine physicians using a standardized ultrasound quality assurance scoring scale (1-5 points). RESULTS The difference in mean scores between the original image and transmitted image showed a 3.9% decrease in transmitted image scores, with P <0.05 on a paired t test; however, this is not likely a clinically significant decrease. Comparing transmitted images using different SSTV encodings and distances ranging up to 5 mi, 100% of survey respondents determined the images to be clinically usable. This dropped to 75% when significant artifacts were introduced. CONCLUSIONS Slow-scan television image transmission is a viable option for transmitting ultrasound images in remote areas where more modern forms of communication are unavailable or not practical. Slow-scan television may have potential as another data transmission option in the wilderness, such as electrocardiogram tracings.
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Baloescu C, Parhar A, Liu R, Wanjiku GW. Effect of Point-of-Care Ultrasound on Clinical Outcomes in Low-Resource Settings: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1711-1719. [PMID: 35786524 DOI: 10.1016/j.ultrasmedbio.2022.04.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Despite the potential for improved patient care, little is known of the true effect of point-of-care ultrasound (POCUS) on patient outcomes in resource-limited settings. Electronic databases were searched using medical subject heading and free text terms related to POCUS and resource-limited settings through August 2020. Two authors independently selected studies, assessed methodological quality using the Downs and Black scale and extracted data. Twenty observational studies were included in the final review. All studies had moderate to high risk of bias. No studies exhibited an effect on the pre-specified primary outcome of mortality. Varying degrees of change in differential diagnosis and management were reported, but definitions varied widely among studies. Estimates for change in diagnosis as a result of POCUS ranged from 15% to 52%, and those for change in management, from 17% to 87%. Articles on POCUS clinical utility represent a small part (4.6%) of the scholastic literature dedicated to POCUS in low-resource settings. POCUS is a valuable intervention to consider in resource-limited settings, with the potential to change diagnosis and patient management. The exact magnitude of effect remains unknown. There is a continued need for large-scale experimental studies to investigate the effect of POCUS on patient diagnosis, management and mortality.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Arya Parhar
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Rachel Liu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace W Wanjiku
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Sullivan JF, do Brasil (Res) M, Roman JW, Milder EA, Carter E, Lennon RP. Utility of Point of Care Ultrasound in Humanitarian Assistance Missions. Mil Med 2021; 186:789-794. [PMID: 33499456 DOI: 10.1093/milmed/usaa348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.-Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon. MATERIALS AND METHODS Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded. RESULTS Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral. CONCLUSIONS In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.
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Affiliation(s)
- John F Sullivan
- Naval Hospital Jacksonville, Department of Family Medicine, 2080 Child Street, Jacksonville, FL 32214, USA
| | - Marinha do Brasil (Res)
- University of Sao Paulo School of Medicine, Department of Infectious Disease, Sao Paulo, SP 05403000, Brazil
| | - John W Roman
- Naval Medical Center Portsmouth, Department of Dermatology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - Edmund A Milder
- Naval Medical Center San Diego, Department of Pediatrics, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - E Carter
- Naval Hospital Jacksonville, Department of Family Medicine, 2080 Child Street, Jacksonville, FL 32214, USA
| | - Robert P Lennon
- Naval Hospital Jacksonville, Department of Family Medicine, 2080 Child Street, Jacksonville, FL 32214, USA.,Penn State College of Medicine, Department of Family Medicine, 500 University Drive, Hershey, PA 17033, USA
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Snelling PJ, Keijzers G, Byrnes J, Bade D, George S, Moore M, Jones P, Davison M, Roan R, Ware RS. Bedside Ultrasound Conducted in Kids with distal upper Limb fractures in the Emergency Department (BUCKLED): a protocol for an open-label non-inferiority diagnostic randomised controlled trial. Trials 2021; 22:282. [PMID: 33853650 PMCID: PMC8048294 DOI: 10.1186/s13063-021-05239-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children frequently present to the emergency department (ED) with forearm injuries and often have x-rays to determine if there is a fracture. Bedside ultrasound, also known as point-of-care ultrasound (POCUS), is an alternative diagnostic test used to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Prospective studies have demonstrated high agreement between POCUS and x-ray findings. However, whether the initial imaging modality affects the patient's medium-term physical function is unknown. METHODS This is a multicentre, open-label, non-inferiority randomised controlled trial conducted in Australian EDs. Recruitment will continue until 112 children with distal forearm injuries (including 48 buckle fractures) per trial arm have achieved the primary outcome measure. Patients aged 5-15 years presenting with an isolated, acute, clinically non-angulated, distal forearm injury with suspected fracture will have their initial diagnostic approach randomised to either POCUS, performed by a credentialled practitioner, or x-ray imaging. If a cortical breach fracture is identified on POCUS, the patient will receive x-rays and have usual care. If a buckle fracture is identified, the patient will have their forearm placed in a splint and be discharged home. Patients will be followed up at 1, 4 and 8 weeks. The primary outcome is upper limb physical function at 4 weeks, as determined by the Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) tool. Secondary outcomes include healthcare costs, satisfaction, pain, complications, rates of imaging, ED length of stay and diagnostic accuracy. DISCUSSION If POCUS is non-inferior to x-ray in terms of patient's medium-term physical function, it may have an effect on overall health care resource use, including the number of x-ray performed and earlier ED discharge. Although prospective studies have confirmed the accuracy of POCUS, this will be the first RCT to assess non-inferiority of functional outcomes of POCUS to diagnose non-angulated paediatric distal forearm injuries, compared to x-ray. POCUS may be of particular importance in settings where access to x-ray imaging can be limited either during or after-hours, as it can aid the triaging and management of patients. TRIAL REGISTRATION Prospectively registered with the ANZCTR on 29 May 2020 ( ACTRN12620000637943 ).
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Affiliation(s)
- Peter J. Snelling
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland Australia
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland Australia
- Sonography Innovation and Research Group (Sonar Group), Southport, Queensland Australia
- Child Health Research Centre, University of Queensland, Brisbane, Queensland Australia
| | - Gerben Keijzers
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland Australia
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Southport, Queensland Australia
| | - David Bade
- Department of Orthopaedics, Queensland Children’s Hospital, South Brisbane, Queensland Australia
| | - Shane George
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland Australia
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland Australia
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Mark Moore
- Department of Emergency Medicine, Queensland Children’s Hospital, South Brisbane, Queensland Australia
| | - Philip Jones
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland Australia
- Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Herston, Queensland Australia
| | - Michelle Davison
- Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya, Queensland Australia
| | - Rob Roan
- Department of Emergency Medicine, Ipswich Hospital, Ipswich, Queensland Australia
| | - Robert S. Ware
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland Australia
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Karim N, Rybarczyk MM, Jacquet GA, Pousson A, Aluisio AR, Bilal S, Moretti K, Douglass KA, Henwood PC, Kharel R, Lee JA, MenkinSmith L, Moresky RT, Gonzalez Marques C, Myers JG, O’Laughlin KN, Schmidt J, Kivlehan SM. COVID-19 Pandemic Prompts a Paradigm Shift in Global Emergency Medicine: Multidirectional Education and Remote Collaboration. AEM EDUCATION AND TRAINING 2021; 5:79-90. [PMID: 33521495 PMCID: PMC7821062 DOI: 10.1002/aet2.10551] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 05/10/2023]
Abstract
To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.
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Affiliation(s)
- Naz Karim
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Megan M. Rybarczyk
- theDepartment of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Gabrielle A. Jacquet
- theDepartment of Emergency MedicineBoston University School of MedicineBoston Medical CenterBostonMAUSA
| | - Amelia Pousson
- theDepartment of Emergency MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Adam R. Aluisio
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Saadiyah Bilal
- theDepartment of Emergency MedicineIcahn School of Medicine at Mount SinaiNew York CityNYUSA
| | - Katelyn Moretti
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | | | - Patricia C. Henwood
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ramu Kharel
- theDepartment of Emergency MedicineEmory University School of MedicineAtlantaGAUSA
| | - J. Austin Lee
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Lacey MenkinSmith
- theDepartment of Emergency MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Rachel T. Moresky
- theEmergency Medicine DepartmentColumbia University College of Physicians and Surgeons and Columbia University Mailman School of Public Health, Heilbrunn Population and Family HealthNew YorkNYUSA
| | | | - Justin G. Myers
- theDepartment of Emergency MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kelli N. O’Laughlin
- theDepartments of Emergency Medicine and Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jessica Schmidt
- theDepartment of Emergency MedicineUniversity of WisconsinMadisonWIUSA
| | - Sean M. Kivlehan
- and theDepartment of Emergency MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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Recommendations for the use of point-of-care ultrasound (POCUS) by emergency physicians in Canada. CAN J EMERG MED 2020; 21:721-726. [PMID: 31771691 DOI: 10.1017/cem.2019.392] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Utility of Different Lung Ultrasound Simulation Modalities Used by Paramedics during Varied Ambulance Driving Conditions. Prehosp Disaster Med 2020; 36:42-46. [PMID: 33109288 DOI: 10.1017/s1049023x20001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Prehospital use of lung ultrasound (LUS) by paramedics to guide the diagnoses and treatment of patients has expanded over the past several years. However, almost all of this education has occurred in a classroom or hospital setting. No published prehospital use of LUS simulation software within an ambulance currently exists. STUDY OBJECTIVE The objective of this study was to determine if various ambulance driving conditions (stationary, constant acceleration, serpentine, and start-stop) would impact paramedics' abilities to perform LUS on a standardized patient (SP) using breath-holding to simulate lung pathology, or to perform LUS using ultrasound (US) simulation software. Primary endpoints included the participating paramedics': (1) time to acquiring a satisfactory simulated LUS image; and (2) accuracy of image recognition and interpretation. Secondary endpoints for the breath-holding portion included: (1) the agreement between image interpretation by paramedic versus blinded expert reviewers; and (2) the quality of captured LUS image as determined by two blinded expert reviewers. Finally, a paramedic LUS training session was evaluated by comparing pre-test to post-test scores on a 25-item assessment requiring the recognition of a clinical interpretation of prerecorded LUS images. METHODS Seventeen paramedics received a 45-minute LUS lecture. They then performed 25 LUS exams on both SPs and using simulation software, in each case looking for lung sliding, A and B lines, and seashore or barcode signs. Pre- and post-training, they completed a 25-question test consisting of still images and videos requiring pathology recognition and formulation of a clinical diagnosis. Sixteen paramedics performed the same exams in an ambulance during different driving conditions (stationary, constant acceleration, serpentines, and abrupt start-stops). Lung pathology was block randomized based on driving condition. RESULTS Paramedics demonstrated improved post-test scores compared to pre-test scores (P <.001). No significant difference existed across driving conditions for: time needed to obtain a simulated image; clinical interpretation of simulated LUS images; quality of saved images; or agreement of image interpretation between paramedics and blinded emergency physicians (EPs). Image acquisition time while parked was significantly greater than while the ambulance was driving in serpentines (Z = -2.898; P = .008). Technical challenges for both simulation techniques were noted. CONCLUSION Paramedics can correctly acquire and interpret simulated LUS images during different ambulance driving conditions. However, simulation techniques better adapted to this unique work environment are needed.
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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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Prehospital ultrasound use among Canadian aeromedical service providers - A cross-sectional survey. CAN J EMERG MED 2019; 22:338-341. [PMID: 31813395 DOI: 10.1017/cem.2019.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evidence suggests that prehospital point of care ultrasound (POCUS) may change patient management. It serves as an aid in triage, physical examination, diagnosis, and patient disposition. The rate of adoption of POCUS among aeromedical services throughout Canada is unknown. The objective of this study was to describe current POCUS use among Canadian aeromedical services providers. METHODS This is a cross-sectional observational study. A survey was emailed to directors of government-funded aeromedical services bases in Canada. Data were analyzed using descriptive statistics. RESULTS The response rate was 82.3% (14/17 aeromedical services directors), representing 41 of 46 individual bases. POCUS is used by aeromedical services in British Columbia, Alberta, Saskatchewan, and Manitoba. New Brunswick, Nova Scotia, Prince Edward Island, and Yukon reported they are planning to introduce POCUS within the next year. Ontario and Newfoundland reported they are not using POCUS and are not planning to introduce it. British Columbia is the only province currently using POCUS on fixed-wing aircraft. Most commonly reported frequency of POCUS use on missions was <25%. Most useful applications are assessment for pneumothorax, abdominal free fluid, and cardiac standstill. The most common barrier to POCUS use is cost of training and maintenance of competence. CONCLUSIONS Prehospital POCUS is available in Western Canada with one third of the Canadian population having access to aeromedical services using ultrasound. The Maritimes and the Yukon Territory will further extend POCUS use on fixed-wing aircraft. While there are barriers to POCUS use, those bases that have adopted POCUS consider it valuable.
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Abstract
The use of portable ultrasound (US) devices has increased in recent years and the market has been flourishing. Portable US devices can be subdivided into three groups: laptop-associated devices, hand-carried US, and handheld US devices. Almost all companies we investigated offer at least one portable US device. Portable US can also be associated with the use of different US techniques such as colour Doppler US and pulse wave (PW)-Doppler. Laptop systems will also be available with contrast-enhanced US and high-end cardiac functionality. Portable US devices are effective in the hands of experienced examiners. Imaging quality is predictably inferior to so-called high-end devices. The present paper is focused on portable US devices and clinical applications describing their possible use in different organs and clinical settings, keeping in mind that patient safety must never be compromised. Hence, portable devices must undergo the same decontamination assessment and protocols as the standard equipment, especially smartphones and tablets.
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Napi NM, Zaidan AA, Zaidan BB, Albahri OS, Alsalem MA, Albahri AS. Medical emergency triage and patient prioritisation in a telemedicine environment: a systematic review. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00357-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sellon E, Durdle S, Bailey D. Assessing the utility of ultrasound in the role 2 hospital setting. BMJ Mil Health 2019; 167:323-326. [PMID: 31005886 DOI: 10.1136/jramc-2019-001208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The usefulness of departmental diagnostic ultrasound in the role 2 setting has not been previously evaluated. This is because role 2 hospital manning does not traditionally include a diagnostic radiologist. This study aims to evaluate the usefulness of this added capability in the deployed role 2 hospital setting. METHODS Prospective data were collected using a questionnaire alongside each scan request during the Op TRENTON 3 operational period. This included details of clinical indication and presumptive diagnosis. Scans were acquired and reported as part of routine care. The postscan clinical diagnosis and effect on management plan were determined by the treating clinician and recorded on the questionnaire. Point-of-care and focused assessment with sonography in trauma scans were excluded, as were ultrasound-guided interventional procedures. RESULTS 41 diagnostic departmental scans were included over the six-month period. 68% (28/41) of the scans increased clinical confidence in the management plan, while 29% (12/41) led to an alteration in the management plan. Only one examination (3%) was deemed to have had no clinical impact. Overall, the musculoskeletal scans had the greatest impact on patient management. CONCLUSIONS Constraints of manoeuvrability at role 2 currently preclude the availability of body CT and shift the demand for diagnostic soft tissue imaging to ultrasound. This capability is only possible with the deployment of suitably trained individuals. This study highlights the utility of this capability at role 2. Musculoskeletal ultrasound skills were of particular value, and training should be encouraged among physiotherapists and radiographers in lieu of, where necessary, a suitably trained deployable radiologist.
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Affiliation(s)
- Edward Sellon
- Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Durdle
- Radiology Department, 33 Field Hospital, Gosport, UK
| | - D Bailey
- Radiology Department, 306 Hospital Support Regiment, York, UK
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Mladenovic J, O’Brien MC, Hoppman R. Shaping the Future of Point-of-Care-Ultrasound in Medical Education. South Med J 2018; 111:449-451. [DOI: 10.14423/smj.0000000000000832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nixon G, Blattner K, Muirhead J, Finnie W, Lawrenson R, Kerse N. Scope of point-of-care ultrasound practice in rural New Zealand. J Prim Health Care 2018; 10:224-236. [DOI: 10.1071/hc18031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Point-of-care ultrasound (POCUS) is an increasingly common adjunct to the clinical assessment of patients in rural New Zealand.
AIM
To describe the scope of POCUS being practiced by rural generalist hospital doctors and gain insights, from their perspective, into its effect.
METHODS
This was a mixed-methods descriptive study. Main outcome measures were type and frequency of POCUS being undertaken. A questionnaire was given to POCUS-active rural hospital doctors to survey the effect of POCUS on clinical practice and assess issues of quality assurance.
RESULTS
The most commonly performed scans were: cardiac (18%) and volume scans (inferior vena cava and jugular venous pressure) (14%), followed by gallbladder (13%), kidney (11%), Focused Assessment with Sonography in Trauma (FAST) (7%), bladder (6%), leg veins (6%) and lungs (5%). There was large variation in frequency of scan types between the study hospitals that could not be accounted for by differences in training.
The participating doctors considered that POCUS had a positive and significant effect on their practice, largely by adding to diagnostic certainty. Challenges identified included maintenance of POCUS skills, lack of systems for POCUS set-up and the absence of quality assurance for POCUS in rural hospitals.
DISCUSSION
Rural generalists consider the broad scope of POCUS they practise to be an important but challenging skill set. Clinical governance, including an agreed scope and standards, may increase the benefits and improve the safety of rural POCUS.
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Haney K, Tandon P, Divi R, Ossandon MR, Baker H, Pearlman PC. The Role of Affordable, Point-of-Care Technologies for Cancer Care in Low- and Middle-Income Countries: A Review and Commentary. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2017; 5:2800514. [PMID: 29204328 PMCID: PMC5706528 DOI: 10.1109/jtehm.2017.2761764] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 12/22/2022]
Abstract
As the burden of non-communicable diseases such as cancer continues to rise in low- and middle-income countries (LMICs), it is essential to identify and invest in promising solutions for cancer control and treatment. Point-of-care technologies (POCTs) have played critical roles in curbing infectious disease epidemics in both high- and low-income settings, and their successes can serve as a model for transforming cancer care in LMICs, where access to traditional clinical resources is often limited. The versatility, cost-effectiveness, and simplicity of POCTs warrant attention for their potential to revolutionize cancer detection, diagnosis, and treatment. This paper reviews the landscape of affordable POCTs for cancer care in LMICs with a focus on imaging tools, in vitro diagnostics, and treatment technologies and aspires to encourage innovation and further investment in this space.
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Affiliation(s)
- Karen Haney
- Dell Medical SchoolThe University of Texas at Austin
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Rowlands R, Rippey J, Tie S, Flynn J. Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children. J Emerg Med 2016; 52:208-215. [PMID: 27814988 DOI: 10.1016/j.jemermed.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Painful forearm injuries after a fall occur frequently in children. X-ray study is currently the gold standard investigation. Ultrasound (US) is a potential alternative that avoids exposure to ionizing radiation and may be less painful than x-ray study; and familiarity and skill with US is increasing among emergency physicians. OBJECTIVES The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children. Secondary aims were to compare any pain or discomfort associated with clinical examination, US, and x-ray study and to determine the acceptability of US as a diagnostic tool to parents and patients. METHODS A prospective, nonrandomized, interventional diagnostic study was performed on children between the ages of 0 and 16 years who had a suspected fracture of the forearm. US scanning was performed by a group of physicians, most with little or no previous US experience. RESULTS After the brief training program, a group of pediatric emergency physicians could diagnose forearm fractures in children with a sensitivity of 91.5% and a specificity of 87.6%. Pain associated with US was no better or worse than pain associated with x-ray study. Patients and parents preferred US over x-ray study as an investigation modality for suspected forearm fractures. CONCLUSION A group of pediatric emergency physicians with limited previous experience could, after a short training program, diagnose forearm fractures in children. Pain associated with US was no better or worse than pain associated with x-ray study.
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Affiliation(s)
- Rachel Rowlands
- Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - James Rippey
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
| | - Sing Tie
- Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, Australia
| | - James Flynn
- Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia
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Abstract
Over the past few decades, point-of-care ultrasound (PoCUS) has come to play a major role in the practice of emergency medicine. Despite its numerous benefits, there has been a slow uptake of PoCUS use in rural emergency departments. Surveys conducted across Canada and the United States have identified a lack of equipment, training, funding, quality assurance, and an inability to maintain skills as major barriers to PoCUS use. Potential solutions include expanding residency training in ultrasound skills, extending funding for PoCUS training to rural physicians in practice, moving PoCUS training courses to rural sites, and creating telesonography training for rural physicians. With these barriers identified and solutions proposed, corrective measures must be taken so that the benefits of PoCUS are extended to patients in rural Canada where, arguably, it has the greatest potential for benefit when access to advanced imaging is not readily available.
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Winn S, McKeown P, Lotfipour S, Maguire GA, Youm JH, Wiechmann W, Fox JC. Remote, Synchronous, Hands-On Ultrasound Education. Telemed J E Health 2015; 21:593-7. [DOI: 10.1089/tmj.2014.0050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephen Winn
- University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Peter McKeown
- University of New England School of Rural Medicine, Armidale, New South Wales, Australia
| | - Shahram Lotfipour
- University of California, Irvine School of Medicine, Irvine, California
| | - Gerald A. Maguire
- University of California, Riverside School of Medicine, Riverside, California
| | - Julie H. Youm
- University of California, Irvine School of Medicine, Irvine, California
| | - Warren Wiechmann
- University of California, Irvine School of Medicine, Irvine, California
| | - J. Christian Fox
- University of California, Irvine School of Medicine, Irvine, California
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21
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Abstract
BACKGROUND Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
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Affiliation(s)
- Douglas G. Sward
- Department of Emergency Medicine, University of Maryland School of Medicine, Hyperbaric Medicine, Shock Trauma Center, Baltimore, Maryland, USA
| | - Brad L. Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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22
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Rudolph SS, Sørensen MK, Svane C, Hesselfeldt R, Steinmetz J. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients--a systematic review. Resuscitation 2013; 85:21-30. [PMID: 24056394 DOI: 10.1016/j.resuscitation.2013.09.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/18/2013] [Accepted: 09/15/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Advances in technology have made prehospital ultrasound (US) examination available. Whether US in the prehospital setting can lead to improvement in clinical outcomes is yet unclear. OBJECTIVE The aim of this systematic review was to assess whether prehospital US improves clinical outcomes for non-trauma patients. METHOD We conducted a systematic review on non-trauma patients who had an US examination performed in the prehospital setting. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the ISI Web of Science and the references of the included studies for additional relevant studies. We then performed a risk of bias analysis and descriptive data analysis. RESULTS We identified 1707 unique citations and included ten studies with a total of 1068 patients undergoing prehospital US examination. Included publications ranged from case series to non-randomized, descriptive studies, and all showed a high risk of bias. The large heterogeneity between the different studies made further statistical analysis impossible. CONCLUSION There are currently no randomized, controlled studies on the use of US for non-trauma patients in the prehospital setting. The included studies were of large heterogeneity and all showed a high risk of bias. We were thus unable to assess the effect of prehospital US on clinical outcomes. However, consistent reports suggested that US may improve patient management with respect to diagnosis, treatment, and hospital referral.
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Affiliation(s)
- Søren Steemann Rudolph
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark.
| | | | - Christian Svane
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
| | - Rasmus Hesselfeldt
- Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
| | - Jacob Steinmetz
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
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Austere, remote, and disaster medicine missions: an operational mnemonic can help organize a deployment. South Med J 2013; 106:89-93. [PMID: 23263320 DOI: 10.1097/smj.0b013e31827c5a2e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical care in resource-limited environments (austere settings) can occur in the context of a disaster, wilderness, or a tactical field operation. Regardless of the type of environment, there are common organizational themes in most successful humanitarian missions that occur in harsh natural or manmade environmental conditions. These principles prioritize the initiation and execution of any given deployment in austere or remote settings, diverging from priorities that would occur in a situation in which change to the existing medical structure is intact and operating well. Attention to these priorities not only helps providers to deliver medical care to people in need during a period of resource limitations but it also can keep providers, teams, the public, and patients safe during and after a deployment.
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Beggs AD, Thomas PR. Point of use ultrasound by general surgeons: Review of the literature and suggestions for future practice. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2012.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Elfarnawany M, Pinter SZ, Lacefield JC. Improved objective selection of power Doppler wall-filter cut-off velocity for accurate vascular quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1429-1439. [PMID: 22579545 DOI: 10.1016/j.ultrasmedbio.2012.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 02/22/2012] [Accepted: 03/19/2012] [Indexed: 05/31/2023]
Abstract
The wall-filter selection curve method is proposed to objectively identify a cut-off velocity that minimizes artifacts in power Doppler images. A selection curve, which is constructed by plotting the color pixel density (CPD) as a function of the cut-off velocity, exhibits characteristic intervals hypothesized to include the optimum cut-off velocity. This article presents an improved implementation of the method that automatically detects characteristic intervals in a selection curve and selects an operating point cut-off velocity along a characteristic interval. The method is applied to subregions within the Doppler image to adapt the cut-off velocity to local variations in vascularity. The method's performance is evaluated in 30-MHz power Doppler images of a four-vessel flow phantom. At high (>5 mm/s) flow velocities, qualitative improvements in vessel delineation are achieved and the CPD in the resulting images is accurate to within 3% of the vascular volume fraction of the phantom.
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Affiliation(s)
- Mai Elfarnawany
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
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Simple, almost anywhere, with almost anyone: remote low-cost telementored resuscitative lung ultrasound. ACTA ACUST UNITED AC 2012; 71:1528-35. [PMID: 22182864 DOI: 10.1097/ta.0b013e318232cca7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Apnea (APN) and pneumothorax (PTX) are common immediately life-threatening conditions. Ultrasound is a portable tool that captures anatomy and physiology as digital information allowing it to be readily transferred by electronic means. Both APN and PTX are simply ruled out by visualizing respiratory motion at the visceral-parietal pleural interface known as lung sliding (LS), corroborated by either the M-mode or color-power Doppler depiction of LS. We thus assessed how economically and practically this information could be obtained remotely over a cellular network. METHODS Ultrasound images were obtained on handheld ultrasound machines streamed to a standard free internet service (Skype) using an iPhone. Remote expert sonographers directed remote providers (with variable to no ultrasound experience) to obtain images by viewing the transmitted ultrasound signal and by viewing the remote examiner over a head-mounted webcam. Examinations were conducted between a series of remote sites and a base station. Remote sites included two remote on-mountain sites, a small airplane in flight, and a Calgary household, with base sites located in Pisa, Rome, Philadelphia, and Calgary. RESULTS In all lung fields (20/20) on all occasions, LS could easily and quickly be seen. LS was easily corroborated and documented through capture of color-power Doppler and M-mode images. Other ultrasound applications such as the Focused Assessment with Sonography for Trauma examination, vascular anatomy, and a fetal wellness assessment were also demonstrated. CONCLUSION The emergent exclusion of APN-PTX can be immediately accomplished by a remote expert economically linked to almost any responder over cellular networks. Further work should explore the range of other physiologic functions and anatomy that could be so remotely assessed.
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Ultrasound in austere settings: a case report from a field hospital in Haiti. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
This case report from a field hospital in post-earthquake Haiti underscores the utility of portable ultrasound in austere environments. An 8-year-old boy was evaluated for several weeks of fevers and chills, general malaise, and increasing abdominal girth. He appeared ill with mild tachypnea, decreased breath sounds at bilateral lung bases, a distended abdomen with a palpable fluid wave, and bilateral pitting edema. This clinical picture was concerning for advanced schistosomiasis and ultrasound findings supported this presumptive diagnosis and helped direct treatment. Images from this case demonstrated several classic ultrasound findings described by the WHO including hepatosplenomegaly and diffuse fibrotic changes in the hepatobiliary and urogenital tracts. This case report demonstrates the effective use of portable ultrasound in making an accurate diagnosis and forming a definitive treatment plan for a patient in a resource-limited environment.
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