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Introduction Thoracic ultrasound is frequently used in the emergency department (ED) to determine the etiology of dyspnea, yet its use is not widespread in the prehospital setting. We sought to investigate the feasibility and diagnostic performance of paramedic acquisition and assessment of thoracic ultrasound images in the prehospital environment, specifically for the detection of B-lines in congestive heart failure (CHF). Methods This was a prospective observational study of a convenience sample of adult patients with a chief complaint of dyspnea. Paramedics participated in a didactic and hands-on session instructing them how to use a portable ultrasound device. Paramedics assessed patients for the presence of B-lines. Sensitivity and specificity for the presence of bilateral B-lines and any B-lines were calculated based on discharge diagnosis. Clips archived to the ultrasound units were reviewed and paramedic interpretations were compared to expert sonologist interpretations. Results A total of 63 paramedics completed both didactic and hands-on training, and 22 performed ultrasounds in the field. There were 65 patients with B-line findings recorded and a discharge diagnosis for analysis. The presence of bilateral B-lines for diagnosis of CHF yielded a sensitivity of 80.0% (95% confidence interval [CI], 51.4–94.7%) and specificity of 72.0% (95% CI, 57.3–83.3), while presence of any B-lines was 93.3% sensitive (95% CI, 66.0–99.7%), and 50% specific (95% CI, 35.7–64.2%) for CHF. Paramedics archived 117 ultrasound clips of which 63% were determined to be adequate for interpretation. Comparison of paramedic and expert sonologist interpretation of images showed good inter-rater agreement for detection of any B-lines (k = 0.60; 95% CI, 0.36–0.84). Conclusion This observational pilot study suggests that prehospital lung ultrasound for B-lines may aid in identifying or excluding CHF as a cause of dyspnea. The presence of bilateral B-lines as determined by paramedics is reasonably sensitive and specific for the diagnosis of CHF and pulmonary edema, while the absence of B lines is likely to exclude significant decompensated heart failure. The study was limited by being a convenience sample and highlighted some of the difficulties related to prehospital research. Larger funded trials will be needed to provide more definitive data.

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Objectives-B-lines are ultrasound artifacts that can be used to detect a variety of pathologic lung conditions. Computer-aided methods to detect and quantify B-lines may standardize quantification and improve diagnosis by novice users. We sought to test the performance of an automated algorithm for the detection and quantification of B-lines in a handheld ultrasound device (HHUD).Methods-Ultrasound images were prospectively collected on adult emergency department patients with dyspnea. Images from the first 124 patients were used for algorithm development. Clips from 80 unique subjects for testing were randomly selected in a predefined proportion of B-lines (0 B-lines, 1-2 B-lines, 3 or more B-lines) and blindly reviewed by five experts using both a manual and reviewer-adjusted process. Intraclass correlation coefficient (ICC) and weighted kappa were used to measure agreement, while an a priori threshold of an ICC (3,k) of 0.75 and precision of 0.3 were used to define adequate performance.Results-ICC between the algorithm and manual count was 0.84 (95% confidence interval [CI] 0.75-0.90), with a precision of 0.15. ICC between the reviewer-adjusted count and the algorithm count was 0.94 (95% CI 0.90-0.96), and the ICC between the manual and reviewer-adjusted counts was 0.94 (95% CI 0.90-0.96). Weighted kappa was 0.72 (95% CI 0.49-0.95), 0.88 (95% CI 0.74-1), and 0.85 (95% CI 0.89-0.96), respectively.Conclusions-This study demonstrates a high correlation between point-of-care ultrasound experts and an automated algorithm to identify and quantify B-lines using an HHUD. Future research may incorporate this HHUD in clinical studies in multiple settings and users of varying experience levels.

Study Objective: The onset of the COVID-19 pandemic forced the health care industry to consider telemedicine as the primary modality for health care with focus on value and ease for providers and patients alike to achieve outcomes similar to face-to-face primary care (PC), urgent care (UC), and emergency department (ED) visits. It remained unclear if telemedicine visits actually achieved first contact resolution (FCR), fully meeting the patients' needs through their virtual care experience. At a time when Florida ranked #3 in its COVID-19 census, Veterans needed access to timely care to answer their concerns and questions. This is even more important as Veterans tend to have multiple comorbidities, translating into increased risk of morbidity and mortality with COVID-19. VISN 8, a region of the U.S. Department of Veteran Affairs (VA) that covers most of Florida, South Georgia, Puerto Rico, and the U.S. Virgin Islands, established a Clinical Contact Center (CCC) in July 2019. The CCC is a 24/7 virtual urgent care organization providing episodic care via telephone and video with physicians and nurse practitioners who work 7 days a week from 7A to 11:30P. A physician was available overnight for COVID-19-related concerns. This study examined the change in CCC workload as a result of the COVID-19 pandemic and assessed first contact resolution (FCR) for patients with COVID-19 related chief complaints.Methods: This was a retrospective study centered around March 11, 2020, when the World Health Organization (WHO) declared a pandemic. This analysis included a sample size of 6,660 patient episodes between March -August 2020. Our outcome variable of interest was FCR. We constructed a binary disposition variable of "stay at home" or "other" which included presentation to the ED or PC. Data collected included patient age, sex, race/ethnicity, COVID-19-related chief complaints, and visit modality (phone versus video). We used a logistic regression to examine factors affecting the probability that patients remained at home. A VA IRB determined that the study was exempt from review.Results: Figure 1 displays the increase in CCC workload during the pandemic starting in March 2020 with a sustained ability to achieve FCR. During the pandemic, patients with suspected COVID-19 were 2.75 times more likely to stay at home than patients calling with non-COVID-19 related chief complaints. This suggests that telemedicine offers significant public health value to patients who are not presenting to the ED or for PC visits potentially exposing themselves and others to the spread of the virus. The control variables of sex and visit modality were found to not be statistically significant.Conclusion: This study established the value of telemedicine in a pandemic with FCR and avoidance of public spaces that could potentially lead to a COVID-19 infection. The service provided by the CCC was invaluable to Veterans as they sought out timely care.