US Study: Medics can do ultrasonography in a moving ambulance
Prehospital ultrasonography being used in parts of Europe, but still in 'early development stage' in United States
Reuters Health Medical News
MINNEAPOLIS — Paramedics can obtain and interpret ultrasonograms in the back of moving ambulances, new research confirms.
Prehospital ultrasonography has been successfully implemented and is being consistently used in Germany, France, Italy, and some Scandinavian countries, but in the U.S. it's "still in the early development stage," according to lead author Dr. William Heegaard of Hennepin County Medical Center in Minneapolis and colleagues.
In an observational pilot study reported online May 14th in Academic Emergency Medicine, the researchers analyzed the performance of 40 paramedics who obtained and interpreted FAST (Focused Assessment Sonography in Trauma) and AA (abdominal aortic) exams under real field conditions. Each paramedic completed a 6-hour training program with ongoing refresher courses.
The paramedics (who worked for two different emergency services agencies) were instructed to perform ultrasonography on all patients with significant trauma or abdominal pain, but without delaying standard treatment or transport. Studies were done in the ambulance, either at the scene or en route to the hospital. (The authors admit that because the number of ultrasound machines was limited, the patients in the study were basically a convenience sample.)
To be considered adequate, the AA studies required a 6-second video clip (either cross-sectional short axis or longitudinal long axis), and the FAST studies required a 6-second clip that shows the diaphragm, the lower tip of the liver, Morrison's pouch in the right upper quadrant, and the entire perisplenic view including the tip and the diaphragm in the left upper quadrant.
Overall, the study involved 104 patients. Twenty patients had AA exams, which were read as negative by the paramedics — and also by an emergency physician who reviewed the studies without knowing the paramedics' interpretation.
Out of 84 FAST exams, the paramedics (and the reviewer) interpreted 6 (7.1%) as positive for free intraperitoneal or pericardial fluid. In 8 FAST cases (7.7%), the paramedics could not obtain adequate images.
There was 100% agreement between the paramedics and the reviewer.
"Prehospital ultrasound has the potential to improve patient outcomes by improving time to diagnosis and early delivery of critically ill patients who are amenable to time-dependent lifesaving interventions," the researchers note. "It also has the promising ability to assist in making appropriate destination decisions for the patient."
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