By Martín Bilbao
The Olympian
THURSTON COUNTY, Wash. — Ultrasound devices onboard Thurston County ambulances are helping paramedics more efficiently diagnose and treat patients in life-or-death situations.
The county’s Medic One program is an early adopter of onboard ultrasound devices, Thurston County Emergency Services Director Ben Miller-Todd said. Local paramedics started using the handheld devices in 2023 to better see into patient bodies and scaled up their use in 2024, he said.
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The devices in use are durable and connect directly to a tablet or phone for easy viewing, Miller-Todd said. In 2025, the first full year all eight Medic One ambulances were equipped with the devices, about 17.8% of all paramedic level dispatches had a documented ultrasound use, he said. That represents 1,643 calls, he added.
Medic One is a county-wide emergency medical services system (EMS). In September 2025, the county became the first in the U.S. to be accredited for onboard ultrasound use by the American College of Emergency Physicians Clinical Ultrasound Accreditation Program. While other healthcare providers can easily procure ultrasound devices, this achievement proves the county’s paramedics are meeting the same standards required of hospital emergency departments, Miller-Todd said.
In addition to Thurston County, Pierce, Snohomish and San Juan counties have approved EMS protocols that include ultrasound use, according to Washington State Department of Health spokesperson Frank Ameduri. However, Miller-Todd said Thurston County has the most “robust protocols and intensive training program” for onboard ultrasound use in the state.
“This is one of those things that helps to highlight how we’re creating and maintaining a world-class system that is continuously evolving medicine, engaging with best practices and really changing patient lives,” Miller-Todd said.
The Olympian visited the county’s Medic One offices in Olympia on Friday to learn more about the ultrasound initiative and its efficacy. How can it make a difference?
Ciaran Keogh, a paramedic and firefighter with the City of Olympia, said he pitched the ultrasound devices to Medic One in 2022. He said he learned about use cases in emergency medicine journals, blogs and podcasts.
“The mantra used there was bringing upstairs care downstairs, (meaning) bringing critical care medicine down into the emergency department,” Keogh said. “And I thought we could take that a step further and bring inside care outside.”
Keogh said the ultrasounds have been making a difference. He recounted how the device allowed him to identify a pulmonary embolism, a blood clot in a lung artery, in a patient.
“That’s something that we can kind of have an inkling for based on history and clinical presentation, but in the prehospital setting, there’s no way to definitively say this is that,” Keogh said.
Yet with this device, Keogh was able to make out the problem and share images with Anders Conway, an emergency medicine physician who serves as the Thurston County Assistant Medical Director.
“That patient was really not looking well and it might have been tempting for Ciaran or me to be like, ‘You know what? This feels like this isn’t going to be safe. This patient is just going to get worse. We should intubate them.’ “Conway said. “That’s the wrong thing to do for that patient once you know they have a pulmonary embolism. So, that potentially spared them a threatening procedure.”
Larry Fontanilla, Medical Program Director for Thurston County EMS, said Keogh observed the clot move through the patient’s heart with the ultrasound device.
If Keogh did not have the device to observe that, it may have taken Conway about 45 minutes to diagnose the problem at the emergency department. Fortunately, the patient got the correct treatment more quickly than they would have otherwise.
“It gave her the best care for her specific condition,” Fontanilla said. “Whereas nine times out of 10 other patients in respiratory distress, intubating would have been the right choice.”
The technology can also help paramedics identify the cause of traumatic bleeding as well as differentiate between causes of cardiac arrest, some of which cannot be treated by defibrillators, according to a county news release.
In tragic situations, Fontanilla said the devices may also give paramedics and family a visual indication that a person can no longer be saved.
“You never want to say, ‘There’s nothing more we can do,’” Fontanilla said. “It’s always a struggle. But, when you can put that probe on and see that the heart is doing absolutely nothing, it gives you more of that assurance, ‘Oh we really did everything possible. There’s nothing more that could be done.’ So, you rest a little easier.” How did the ultrasound initiative get going?
The county budgeted $200,000 to get this initiative going, Miller-Todd said.
Just under $50,000 was spent on equipment, warranties and related subscriptions from a company called Butterfly, according to a bill shared by Miller-Todd. That includes 14 ultrasound devices, which are listed at $2,400 each, he said.
The county partnered with Madigan Army Medical Center to train 80 paramedics to proficiently use the ultrasound devices, according to the release.
Miller-Todd said organizing the training proved to be a logistical challenge, especially as they managed pandemic-related staffing shortfalls, but he’s proud of the work his team put into it.
“To get 80 paramedics off duty in a dedicated 18-hour course throughout 2024 in three different agencies and three different labor groups and trying to coordinate that with physician support and the multiple trainings we did, course after course to clean up, it was exhausting,” Miller-Todd said.
Each paramedic trained over 18 hours at the cost of about $450, Miller-Todd said. The final bill for the trainings was about $90,000 rather than an expected $150,000, he added.
Landing on protocols for using the technology was also a stressor, Miller-Todd said. There was a spectrum of thought that needed to be negotiated, he added.
“You want debate and thoughts in every implementation to make sure you have the best endpoint for the community you’re serving,” Miller-Todd said. “That took time and energy and debate.”
Keogh said there’s been positive feedback from the paramedics. Even those who were more skeptical of the new, mandatory trainings were swayed by the usefulness of the technology, he added.
“By the second day, one of those people who was really outright against it, said ‘Hey, I totally changed my mind,’” Keogh said.
The partnership with Madigan Army Medical Center went beyond just training. They’ve helped review data, answer questions and oversee quality assurance, Fontanilla and Conway said.
“There’s an academic prowess associated with Madigan in terms of stepping in and making sure we’re checking boxes,” Miller-Todd said.
Already, Thurston County has received inquiries about the ultrasound initiative from other EMS agencies up and down the Interstate 5 corridor, Keogh and Miller-Todd said.
“We’re all super excited to be pushing the scope of EMS in a positive direction that presents almost no harm to the patients but opens up so much possibility,” Keogh said.
Editor’s note: This article has been updated with information from the state Department of Health.
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