Emergency Point-of-Care Ultrasound Stewardship – A Joint Position Paper by EuSEM and EFSUMB and Endorsed by IFEM and WFUMB

Abstract

Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EFSUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication.

A Modern Diagnostic Procedure—The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians’ Daily Routine

“…It had a big increase in quality, with artificial intelligence (AI) technology, and a decrease in cost and size in recent years, making it easier to implement in resource-scarce environments and developing parts of the world [ 11 , 12 ]. We find ourselves at a crucial moment in POCUS development due to ease of access—this comes with a risk due to a lack of a generally accepted standard of training and, thus, difficulties in maintaining quality standards with patient care [ 13 ]. POCUS is highly dependent on user skill, and insufficient knowledge can lead to misdiagnosis [ 14 , 15 ].…”

“…In 2023, the European Union Society for Emergency Medicine (EuSEM) and the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) proposed the implementation of European Guidelines that would set a standard for European POCUS stewardship to cater to the different needs encountered in different settings around Europe and combat current faulty practices [ 13 ].…”

Point-of-Care Ultrasound—History, Current and Evolving Clinical Concepts in Emergency Medicine

“…To date, EMUS encompasses five domains (resuscitative, diagnostic, procedural guidance, symptom-or sign-based, and therapeutic) and two applications are distinguished: basic and advanced. These five domains have been described by many publications and are detailed in several emergency medicine society's guidelines and position statements [83,96].…”

“…Additional or alternative means of competence-based supervision can be applied remotely, either with on-site or web-based case simulation. New concepts and ideas are urgently needed to realize this complex and central requirement [83].…”

Point‐of‐care ultrasound in clinical assessment of acute urological emergencies

“…Resources are required for development of appropriate curricula, courses and objective assessment of competency for each new indication. This might include regular training sessions and refreshers with simulation on live or phantom models by triangulation of evidence 40,41 . Input from a multidisciplinary team including radiologists, sonographers and emergency medicine physicians and other specialty clinicians would bring complementary experiences to training.…”