Implementing prehospital point-of-care ultrasound
Examining the hardware and software requirements, and where P-POCUS fits into the EMS scope of practice
The use of ultrasound has a long history in emergency departments to help aid in the diagnoses and treatment of patients. This technology is continuing to make its way into the prehospital setting in an effort to provide better care to patients.
In a session at the EMS World Expo titled, “Lost in the B&W Fuzz: Creating a Prehospital US Program for your EMS Agency,” Stephanie Louka, MD, AEMT, EMS physician, Virginia Commonwealth University (VCU) Health, Richmond, Va., explained how VCU Health implemented prehospital point-of-care ultrasound (P-POCUS) in their service.
Louka provided lessons learned and guidance to anyone who is thinking of implementing this prehospital point-of-care ultrasound into their standard of care and protocols.
Memorable quotes on implementing prehospital point-of-care ultrasound
Here are some memorable quotes from Louka on implementing prehospital point-of-care ultrasound in your organization.
“Think of this as a stethoscope, not a treatment.”
“The hard part about our job in patient assessment is limited resources and limited information.”
“In cardiac arrest, if you think it’s PEA, ultrasound has the capability to confirm fine VF that is otherwise undetectable by the monitor.”
Top takeaways on implementing prehospital point-of-care ultrasound
Here are some of the key takeaways from this session to explain the lessons learned along the way.
1. Understanding the use of prehospital point-of-care ultrasound in EMS
EMS providers have a long list of diagnostic tools and treatment interventions to help in patient care. Louka advised on the possibility of using ultrasound in EMS in the following ways:
- Rapid Ultrasound for shock and hypotension (RUSH) exam
- Cardiac arrest
- Extended focused assessment with sonography in trauma (eFAST) exam
- Thoracic exams
- Procedures including endotracheal tube confirmation and intravenous access
2. Scope of practice, education and training considerations
The National Association of State EMS Officials (NASEMSO) EMS Scope of Practice Model Draft indicates the use of portable technologies has “intentionally been left to the local medical director credentialing.” Furthermore, it advises the use of “non-invasive diagnostic equipment (e.g. ultrasound)” to not be limited to any specific levels of qualification of EMS personnel.
Each service must check with their medical director and State Office of EMS for further guidance or clarification before implementing any prehospital point-of-care ultrasound capabilities. Louka advised attendees collaborate with their medical directors about where this skill fits into their agency’s protocols (i.e., general procedures vs. built-in to specific protocols).
When implementing a new skill, there is always a need for initial training and education prior to using it in the field. Over time, as the program is used, an evaluation of skills and the program may be needed to maintain proficiency through quality assurance, simulations and in-service training. Here are some options Louka found to be helpful in educating and training her providers:
- Affiliation with an academic hospital
- Formalized course (e.g. EMSPOCUS, VCU, etc.), however, these can be limited
- Training by OMD/designee
- Methods: small-groups vs. one-on-one instruction
- Simulation training is valuable, but may be out-of-reach due to budget constraints. An alternative is to search for software or apps that are efficient and meet training objectives, such as, EMSONO and Awesome Ultrasound Simulator.
3. Technical implementation: Hardware/software
When choosing ultrasound devices, there are several different types of hardware and software to choose from. Louka noted the key to acquiring these devices it to decide how it will be used within your service then determine which device would best fit your service’s needs. She listed the following considerations when choosing hardware/software capabilities.
- Probes (e.g. detachable vs. all-in-one probe)
- Storage capacity of the device
- Which type of scanning software comes with the device
- Facilitation of QA
- Manual (email, Google drive, etc.)
- Data recall and storage of image (e.g., can it be stored on the device, on a cell phone, local server, cloud or not at all)
4. Budget and funding
In EMS, it is not uncommon for budgets to be constrained and limited, especially when implementing new diagnostic tools in patient care. Louka suggested the following anticipated costs and potential funding sources for crunching the numbers.
- Hardware (buy or lease)
- Maintenance/software upgrades
- Training (initial and recertification)
Potential funding sources:
- Departmental budget
- Capital campaign
5. Steps to program implementation
Louka advises those thinking about implementing prehospital point-of-care ultrasound procedures to identify the value in tangible benefits for their agency, patients, the community and the taxpayers. Here are the steps she suggests to get this accomplished:
- Write your proposal. Establish a need for this technology when performing patient care by identifying current statistics in your local area that would improve patient care. This includes the advantages of having this equipment and the disadvantages of not having it available that are centered around enhancing decisions and providing appropriate patient treatment that is in the best interest of the patient.
- Identify key stakeholders that will support your proposal. It all starts with the collaboration of your medical director and EMS director.
- Sell your project. Once your stakeholders are on board, sell it. “Talk to anyone that will listen.” Be prepared with a 30-second spiel on the benefits and use of the device to garner support.
- Submit for approval.
- Implement. Come up with a plan to train, educate and implement this program across your organization. QA is a good tool to measure the strength of current protocols to patient care.
- Monitor and refine. Continually monitor the wellness of the program and refine in places where improvement is needed. This could be in data storage, protocols, training requirements, etc.
Learn more about prehospital point-of-care ultrasound
Find additional resources on implementing prehospital point-of-care ultrasound in your agency here:
- Prehospital Ultrasound: Emerging technology for EMS
- Why point-of-care ultrasound should be a mainstay in EMS
- How EMS ultrasound will transform prehospital care
- Prove It: Prehospital ultrasound improves diagnosis, treatment and transport decisions
- Remember 2 Things: Ultrasound use by paramedics
- How an EMS agency is using prehospital ultrasound
This article was originally posted Nov. 18, 2018. It has been updated.