Prehospital Chest Ultrasound by a Dutch Helicopter Emergency Medical Service

Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review

“…Three studies did not clearly specify the breakdown of medical and trauma patients included in their studies [28][29][30]. Ketelaars et al [31] commented that the role of PHUS may be greater than they found due to the nature of their study design: data collection allowed for only one treatment change to be recorded per ultrasound exam. Table 1 shows the summarised findings of the included studies.…”

“…The remaining four studies all reported that PHUS assisted in the diagnosis of pathology in the prehospital environment: out of 15 patients Busch [33] reported two cases of haemoperitoneum and one pneumothorax; Ketelaars et al [31] found the following onscene diagnoses were made: asystole (8% of the total number of trauma scans performed), pneumothorax (9%), haemothorax (1%), and pulmonary contusion (1%). Haemothorax was also specifically excluded in six cases.…”

“…Four studies reported that PHUS results affected prehospital treatment or the choice of destination hospital. Ketelaars et al [31] found that in 21% of cases (60 patients) treatment decision was changed. For example, all treatment was stopped after cardiac imaging (n = 4), IV-fluid therapy was changed (n = 6), a decision was made not to place a chest tube (n = 10), or to place a chest tube (n = 3), and a change in the choice of destination hospital (specifically to go to a hospital instead of no hospital [n = 1], to a lower-level hospital instead of a higher-level hospital [n = 6], and to a higher-level hospital rather than a lower-level one [n = 3]).…”

“…The three other studies reported an unspecified number of receiving hospital changes as a result of PHUS findings which included pre-arrival preparation of the trauma team, preparation of needed resources (i.e. blood products), and preparation of an operating room [26,29,31].…”

“…Of the studies that reported complications preventing successful completion of PHUS, the reported rate was between 5% and 9% of cases [9,26,28,30,31,33]. Factors that affected quality image generation included large patient-body habitus, subcutaneous emphysema, patient positioning, dressings or splints, environmental challenges such as confined space, cold temperatures, high ambient lighting, and rapid transport times.…”