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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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Engelsen PC, Heyerdahl F, Maddali DD, Akhavi MS, Undseth RM, Elle OJ, Brun H. Ascending with ultrasound: telementored eFAST in flight-a feasibility study. Emerg Radiol 2024; 31:25-31. [PMID: 38066242 PMCID: PMC10830595 DOI: 10.1007/s10140-023-02186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Teleultrasound uses telecommunication technologies to transmit ultrasound images from a remote location to an expert who guides the acquisition of images and interprets them in real time. Multiple studies have demonstrated the feasibility of teleultrasound. However, its application during helicopter flight using long-term evolution (LTE) for streaming has not been studied. Therefore, we conducted a study to examine the feasibility of teleultrasound in an Airbus H145 helicopter. METHODS Four anesthesiologists and one military physician were recruited to perform telementored extended Focused Assessment with Sonography in Trauma (eFAST) during nine helicopter flights, each with a unique healthy volunteer. A radiologist was recruited as a remote expert, guiding the physicians in their examinations. The examining physicians reported the user experience of telementored eFAST on a questionnaire, while the remote expert rated the diagnostic quality of the images on a 1-5 Likert scale. In addition, we measured the duration of the examinations and key LTE network parameters including signal strength, quality, and continuity. RESULTS The images were rated to an average of 4.9 by the remote expert, corresponding to good diagnostic quality. The average duration of telementored eFAST was 05:54 min. LTE coverage was negatively affected by proximity to urban areas and ceased above 2000 ft altitude. Occasional audio problems were addressed by using the Voice over LTE network for communication. The examining physicians unanimously reported on the questionnaire that they would use telementored eFAST on patients. CONCLUSION Telementored eFAST is feasible in ambulance helicopters and can produce images of good diagnostic quality. However, it relies on stable LTE coverage, which is influenced by many factors, including the helicopter's altitude and flight path. Furthermore, its benefit on patient outcomes remains to be proven.
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Affiliation(s)
- Peder Christian Engelsen
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Fridtjof Heyerdahl
- The Air Ambulance Department, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Henrik Brun
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
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Gao X, Lv Q, Hou S. Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites. Diagnostics (Basel) 2023; 13:3388. [PMID: 37958284 PMCID: PMC10649742 DOI: 10.3390/diagnostics13213388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.
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Affiliation(s)
- Xing Gao
- Tianjin University Tianjin Hospital, Tianjin 300211, China;
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Tianjin 300072, China
| | - Qi Lv
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Tianjin 300072, China
| | - Shike Hou
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Tianjin 300072, China
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Williamson F, Lawton CF, Wullschleger M. Outcomes in traumatic cardiac arrest patients who underwent advanced life support. Emerg Med Australas 2023; 35:205-212. [PMID: 36218289 DOI: 10.1111/1742-6723.14096] [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: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Survival following a traumatic cardiac arrest (TCA) remains poor despite research focused on specific management and guideline adaptation. Previous research has identified factors including age, arresting rhythm, injury severity and distance from hospital to be associated with prehospital TCA outcomes. The present study aimed to review the local incidence of TCA to inform local practice within a mature trauma system. METHODS A retrospective trauma database review from 2008 to 2021 was conducted at the Royal Brisbane and Women's Hospital. Patients were categorised by prehospital and in-hospital arrest, prehospital return of spontaneous circulation (ROSC), and year in relation to TCA management protocol changes. Descriptive comparative analysis was performed with the primary outcome of interest being survival to hospital discharge. RESULTS Survival to hospital discharge was similar in patients in whom TCA occurred in the prehospital environment and hospital (24 vs 29%). Mechanism of injury, response to intervention and location of cardiac arrest were important outcome associations. Patients with a positive focused assessment with sonography in trauma scan were less likely to achieve ROSC but more likely to survive to discharge. The frequency of prehospital interventions remained similar after the guideline changes; with more patients arriving to the hospital with improved haemodynamic parameters and increased survival. CONCLUSIONS These results support the identification and immediate management of TCA. No patients survived if they did not achieve ROSC by hospital arrival, questioning the role for aggressive management beyond the ED in this cohort. Future research will focus on the identification of patients with potentially positive survival outcomes and further define futile intervention factors.
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Affiliation(s)
- Frances Williamson
- Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Catherine F Lawton
- Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Martin Wullschleger
- Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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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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Muchnok D, Vargo A, Deeb AP, Guyette FX, Brown JB. Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression. JAMA Surg 2022; 157:934-940. [PMID: 35976642 PMCID: PMC9386601 DOI: 10.1001/jamasurg.2022.3552] [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: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022]
Abstract
Importance Prehospital needle decompression (PHND) is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain. Objective To determine the association of PHND with early mortality in patients requiring emergent chest decompression. Design, Setting, and Participants This was a retrospective cohort study conducted from January 1, 2000, to March 18, 2020, using the Pennsylvania Trauma Outcomes Study database. Patients older than 15 years who were transported from the scene of injury were included in the analysis. Data were analyzed between April 28, 2021, and September 18, 2021. Exposures Patients without PHND but undergoing tube thoracostomy within 15 minutes of arrival at the trauma center were the comparison group that may have benefited from PHND. Main Outcomes and Measures Mixed-effect logistic regression was used to determine the variability in PHND between patient and EMS agency factors, as well as the association between risk-adjusted 24-hour mortality and PHND, accounting for clustering by center and year. Propensity score matching, instrumental variable analysis using EMS agency-level PHND proportion, and several sensitivity analyses were performed to address potential bias. Results A total of 8469 patients were included in this study; 1337 patients (11%) had PHND (median [IQR] age, 37 [25-52] years; 1096 male patients [82.0%]), and 7132 patients (84.2%) had emergent tube thoracostomy (median [IQR] age, 32 [23-48] years; 6083 male patients [85.3%]). PHND rates were stable over the study period between 0.2% and 0.5%. Patient factors accounted for 43% of the variation in PHND rates, whereas EMS agency accounted for 57% of the variation. PHND was associated with a 25% decrease in odds of 24-hour mortality (odds ratio [OR], 0.75; 95% CI, 0.61-0.94; P = .01). Similar results were found in patients who survived their ED stay (OR, 0.68; 95% CI, 0.52-0.89; P < .01), excluding severe traumatic brain injury (OR, 0.65; 95% CI, 0.45-0.95; P = .03), and restricted to patients with severe chest injury (OR, 0.72; 95% CI, 0.55-0.93; P = .01). PHND was also associated with lower odds of 24-hour mortality after propensity matching (OR, 0.79; 95% CI, 0.62-0.98; P = .04) when restricting matches to the same EMS agency (OR, 0.74; 95% CI, 0.56-0.99; P = .04) and in instrumental variable probit regression (coefficient, -0.60; 95% CI, -1.04 to -0.16; P < .01). Conclusions and Relevance In this cohort study, PHND was associated with lower 24-hour mortality compared with emergent trauma center chest tube placement in trauma patients. Although performed rarely, PHND can be a life-saving intervention and should be reinforced in EMS education for appropriately selected trauma patients.
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Affiliation(s)
- Daniel Muchnok
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Allison Vargo
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew-Paul Deeb
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X. Guyette
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joshua B. Brown
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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7
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Dewar ZE, Ko S, Rogers C, Oropallo A, Augustine A, Pamula A, Berry CL. Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study. Ultrasound J 2022; 14:23. [PMID: 35698007 PMCID: PMC9191400 DOI: 10.1186/s13089-022-00270-w] [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: 02/27/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00270-w.
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Affiliation(s)
- Zachary E Dewar
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA.
| | - Stephanie Ko
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA.,Wilkes University, 84 West South Street, Wilkes-Barre, PA, 18766, USA
| | - Cameron Rogers
- Greater Valley EMS, 904 North Lehigh Ave, Sayre, PA, 18840, USA
| | - Alexis Oropallo
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| | - Andrew Augustine
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| | - Ankitha Pamula
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
| | - Christopher L Berry
- Department of Emergency Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA, 18840, USA
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Li J, McMullan JT. Prehospital Ultrasound for Endotracheal Tube Confirmation: Better Alternatives Exist. Respir Care 2022; 67:613-615. [PMID: 35473849 PMCID: PMC9994249 DOI: 10.4187/respcare.09702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
| | - Jason T McMullan
- Correspondence: Jason T McMullan MD, 321 Albert Sabin Way, ML0769 Cincinnati, OH 45267-0769. E-mail:
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Partyka C, Coggins A, Bliss J, Burns B, Fiorentino M, Goorkiz P, Miller M. A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service. Emerg Radiol 2021; 29:299-306. [PMID: 34817706 DOI: 10.1007/s10140-021-02002-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS physicians. METHODS Trauma patients who received prehospital eFAST by HEMS clinicians between January 2013 and December 2017 were reviewed. The clinician's interpretations of these ultrasounds were compared to gold standard references of CT imaging or operating room findings. The outcomes measured include the calculated accuracy of eFAST for detecting intraperitoneal free fluid (IPFF), pneumothorax, hemothorax, and pericardial fluid compared to available gold standard results. RESULTS Of the 411 patients with adequate data for comparison, the median age was 39.5 years with 73% male and 98% sustaining blunt force trauma. For the detection of IPFF, eFAST had a sensitivity of 25% (95% CI 16-36%) and specificity of 96% (95% CI 93-98%). Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), hemothorax (17% and 97% respectively), and pericardial effusion (17% and 100% respectively). These results did not change significantly when reassessed with several sensitivity analyses. CONCLUSION Prehospital eFAST is reliable for detecting the presence of intraperitoneal free fluid. This finding should inform receiving trauma teams to prepare for early definitive care in these patients. The low sensitivities across all components of the eFAST highlight the importance of cautiously interpreting negative studies while prompting the need for further studies. TRIAL REGISTRATION ACTRN12618001973202 (Registered on 06/12/2018).
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Affiliation(s)
- Christopher Partyka
- Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia. .,Emergency Department, Liverpool Hospital, Liverpool, NSW, Australia. .,South Western Sydney Clinical School, University of New South Wales, Kensington, Australia.
| | - Andrew Coggins
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Jimmy Bliss
- Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia.,Emergency Department, Liverpool Hospital, Liverpool, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brian Burns
- Sydney Medical School, University of Sydney, Sydney, Australia.,GSA-HEMS, NSW Ambulance, Blacktown, NSW, Australia
| | | | - Pierre Goorkiz
- Intensive Care Unit, Liverpool Hospital, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Matthew Miller
- Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia.,UNSW St George and Sutherland Clinical Schools, Kogarah, Australia
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Luckey-Smith K, King B, Boyd JS. Is E-Learning Education Effective in Increasing the Ability of Nonphysician Medical Flight Crewmembers to Accurately Interpret Point-of-Care Lung and Cardiac Ultrasound Examinations? Air Med J 2021; 40:119-123. [PMID: 33637275 DOI: 10.1016/j.amj.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Patients suffering from severe injury or illness can benefit from the care and transport of helicopter emergency medical services (HEMS). This may be due to the speed of transport, level of care, expertise of flight crews, and access to specialized equipment and tools. One such tool is point-of-care ultrasound (POCUS). POCUS-based lung and cardiac evaluations can positively influence the assessment and care provided to critically ill HEMS patients, but how these procedures can best be learned by nonphysician flight crewmembers has not been fully explored. METHODS In this prospective, interventional study, 26 flight crewmembers were evaluated before and after a succinct, guided educational intervention focused on the use of free open-access medical education material intended to help them acquire the knowledge needed to accurately identify and interpret POCUS assessments. RESULTS After completing the educational intervention, participants had a statistically significant improvement in their postintervention scores. CONCLUSION This study supports the use of free open-access medical education material in improving the knowledge needed for nonphysician flight crewmembers to interpret basic lung and cardiac ultrasound images. Integrating this information into educational programs may contribute to increased comfort and proficiency and serve to accelerate the adoption of this tool in the air medical environment.
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Affiliation(s)
- Kyle Luckey-Smith
- Queen Mary University of London, London, United Kingdom; Vanderbilt University Medical Center, LifeFlight, Nashville, TN.
| | - Brent King
- University of Maryland School of Medicine, Baltimore, MD
| | - Jeremy S Boyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
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Amaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med 2020; 8:2050312120932706. [PMID: 32782792 PMCID: PMC7383635 DOI: 10.1177/2050312120932706] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.
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Affiliation(s)
- Colton B Amaral
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel C Ralston
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
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12
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Duncan PGA, Mackey J. Point-of-care ultrasound at Role 1: is it time for a rethink? BMJ Mil Health 2020; 166:406-410. [DOI: 10.1136/bmjmilitary-2020-001466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/04/2022]
Abstract
IntroductionThe past 20 years have seen a rapid increase in point-of-care ultrasound (POCUS) use in the prehospital sphere. However, in the British Army there is no POCUS capability in the Defence Primary Healthcare (DPHC) or deployed Role 1 setting. POCUS can improve diagnostic capability, influence management decisions and transfer destination, and is a useful triage tool in mass casualty management.MethodA survey on POCUS use was sent to 279 clinicians working in the Role 1, civilian prehospital and Defence Primary Healthcare environments. Questions explored current levels of experience and training, indications for use and attitudes towards roll out. Results were analysed using a mixed methods approach.ResultsThere were 124 respondents (279 recipients; 44.4% response rate). 74.2% (92 respondents) had no experience of using POCUS while 9.7% (12 respondents) were classed as frequent users. The four most common indications for prehospital POCUS were abdominal, cardiac and lung imaging and vascular access. The majority of respondents felt that POCUS would add value in the deployed Role 1 environment; this was even more evident in the frequent user group. Common concerns were difficulty maintaining currency, governance burden and uncertainty over impact on management.ConclusionThe majority of doctors surveyed feel that POCUS would add value at Role 1 and is a capability that should be developed. The authors will watch with interest the progress of Project MORPHO.
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Lung Ultrasound for the Diagnosis and Management of Acute Respiratory Failure. Lung 2020; 198:1-11. [PMID: 31894411 DOI: 10.1007/s00408-019-00309-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 12/14/2022]
Abstract
For critically ill patients with acute respiratory failure (ARF), lung ultrasound (LUS) has emerged as an indispensable tool to facilitate diagnosis and rapid therapeutic management. In ARF, there is now evidence to support the use of LUS to diagnose pneumothorax, acute respiratory distress syndrome, cardiogenic pulmonary edema, pneumonia, and acute pulmonary embolism. In addition, the utility of LUS has expanded in recent years to aid in the ongoing management of critically ill patients with ARF, providing guidance in volume status and fluid administration, titration of positive end-expiratory pressure, and ventilator liberation. The aims of this review are to examine the basic foundational concepts regarding the performance and interpretation of LUS, and to appraise the current literature supporting the use of this technique in the diagnosis and continued management of patients with ARF.
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Thoracic trauma in military settings: a review of current practices and recommendations. Curr Opin Anaesthesiol 2019; 32:227-233. [PMID: 30817399 DOI: 10.1097/aco.0000000000000694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. RECENT FINDINGS Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems. Although Tactical Combat Casualty Care protocol recommends the Cric-Key device for surgical cricothyroidotomies, other devices may offer comparable performance. Recommendations for regional anesthesia after blunt trauma are not well defined. Increasing amounts of evidence favor the use of extracorporeal membrane oxygenation for refractory hypoxemia and resuscitative endovascular balloon occlusion of the aorta (REBOA) for severe hemorrhage. REBOA outcomes are potentially improved by partial occlusion and small 7 Fr catheters. SUMMARY The Global War on Terror has provided opportunities to better understand and treat thoracic trauma in military settings. Trauma registries and other data sources have contributed to significant advancements in the management of thoracic trauma in military and civilian populations.
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Hon S, Fan M, Leung LP, Mok KL, Kwok KM. A short report on the acquisition of point-of-care ultrasound skills and knowledge by the ambulance personnel in Hong Kong. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907918783811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Point-of-care ultrasound plays an important role in patient management in the prehospital setting. Prehospital ultrasound training for the paramedics has been developed in the West for many years. However, the present training curriculum for the local ambulance personnel does not include point-of-care ultrasound. This study is the first of its kind in Hong Kong on the feasibility of teaching ambulance personnel how to perform focused assessment with sonography in trauma by a 1-day course. Objective: It aimed to assess whether the ultrasound-naïve ambulance personnel could acquire the skills and knowledge of point-of-care ultrasound following a tailor-made training programme. Methods: This was a prospective observational study. The training programme was a 1-day course consisted of didactic lectures and hands-on practice. Each participant was assessed by a written test and a skills test. Descriptive statistics were used to describe the ambulance personnel and their results of the written and skills test. Significance testing was by Mann–Whitney U test and Spearman correlation test where appropriate. Results: Seventeen members of Ambulance Service Institute (Hong Kong Branch) participated in the programme. All of them currently are the ambulance personnel and they joined the programme via the captioned institute. Enrollment was voluntary. The median score in the written test was 20 out of 25. The median time to complete the four views of the focused assessment with sonography in trauma scan was 3.4 min. There was no significant relationship between test performance and educational background and work experience of the ambulance personnel. Conclusion: Training the local ambulance personnel point-of-care ultrasound is feasible. Their acquisition of skills and knowledge of point-of-care ultrasound after a 1-day course was satisfactory.
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Affiliation(s)
- Suet Hon
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Min Fan
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ling-Pong Leung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ka-Leung Mok
- Accident & Emergency Department, Ruttonjee Hospital, Hong Kong
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