Prehospital point-of-care ultrasound: A transformative technology

Amaral, Colton B; Ralston, Daniel; Becker, Torben K.

doi:10.1177/2050312120932706

Cited by 35 publications

(30 citation statements)

References 52 publications

(68 reference statements)

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“…The use of POCUS to augment the work of paramedics and first responders has been previously explored, but the size, cost, and necessity for multiple probes inherent to standard machines significantly limited the ability to undertake large scale prehospital studies [ 48 ]. With the advent of HHU devices, research on prehospital POCUS and its effect on patient outcomes is now feasible [ 49 ]. The cost and portability of HHU devices make them ideal diagnostic tools for first responders as well as EPs who staff large-scale events, sometimes in areas with few existing medical resources [ 4 ].…”

Section: Current Use Of Hhus In the Edmentioning

confidence: 99%

“…Their high portability and ability to provide real-time diagnostics make these devices ideal for such circumstances [ 4 ]. Similarly, HHU is proving invaluable to practitioners in austere environments that otherwise have no reliable imaging source [ 3 , 4 , 15 , 49 ]. Burleson et al retrospectively reported the experience of ultrasound-trained physicians using the Butterfly iQ HHU in an austere East African ED [ 8 ].…”

Section: Current Use Of Hhus In the Edmentioning

confidence: 99%

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The Use of Handheld Ultrasound Devices in Emergency Medicine

Malik

Rowland

Haber

et al. 2021

Curr Emerg Hosp Med Rep

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Purpose of Review Ultraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these machines are becoming more common due to ease-of-use, extreme affordability, and improving technology. Recent Findings Images obtained with HHU are comparable to those obtained with traditional machines but create unique issues regarding billing and data management. HHU devices are increasingly used successfully to augment the education of practitioners-in-training, by emergency physicians in austere environments, and in the burgeoning fields of “tele-ultrasound” and augmented reality scanning. Summary This review seeks to describe the current state of use of HHU devices in the emergency department (ED) including device overview, institutional concerns, unique areas of use, recent literature since their adoption into clinical EM, and their future potential.

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Section: Current Use Of Hhus In the Edmentioning

confidence: 99%

Section: Current Use Of Hhus In the Edmentioning

confidence: 99%

The Use of Handheld Ultrasound Devices in Emergency Medicine

Malik

Rowland

Haber

et al. 2021

Curr Emerg Hosp Med Rep

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“…cold, warm, dark, sunny, rain, snow). The evidence for non-physician performed thoracic ultrasound examinations differ regarding feasibility, quality, and accuracy and it is still debated if and how prehospital thoracic ultrasound should be implemented [14][15][16]. Only a few minor published studies explore the feasibility and accuracy of these ultrasound examinations.…”

Section: Introductionmentioning

confidence: 99%

Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study

Pietersen

Mikkelsen

Lassen

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background In a prehospital setting, the severity of respiratory symptoms in patients calling for an ambulance differ. The initial evaluation, diagnosing, and thereby management can be challenging because respiratory symptoms can be caused by disease in many organs. Ultrasound examinations can contribute with important information and support the clinical decision-making. However, ultrasound is user-dependent and requires sufficient knowledge and training. The aim of this study was to explore the quality of thoracic ultrasound examinations performed on patients by emergency medical technicians and paramedics in a prehospital, clinical setting. Methods From November 2018 – April 2020, Danish emergency medical technicians and paramedics (n = 100) performed thoracic ultrasound examinations on patients with respiratory symptoms using a portable ultrasound device. The ultrasound examinations were stored and retrospectively assessed by a reviewer blinded to the patients’ symptoms and history, as well as the emergency medical technicians’ and paramedics’ findings. The image quality was scored from 1 to 5. The findings determined by the reviewer was then correlated with a questionnaire filled out by the emergency medical technicians and paramedics regarding ultrasonic findings and potential change in treatment or management of the patient. The agreement in percentage and as Cohen’s kappa was explored. Results A total of 590 ultrasound examinations were assessed, resulting in a median image quality score of 3 (IQ1 = 4, IQ3 = 3). The overall agreement in percentage between the emergency medical technicians and paramedics and reviewer was high (87.7% for a normal scan, 89.9% for interstitial syndrome, 97.3% for possible pneumothorax, and 96.3% for pleural effusion). Cohen’s kappa varied from 0.01 for possible pneumothorax to 0.69 for pleural effusion. Based on the questionnaires (n = 406), the ultrasound examination entailed a change in treatment or visitation in 48 cases (11.7%) which in this study population encompasses a number-needed-to-scan of 8.5. Conclusion Emergency medical technicians and paramedics perform focused thoracic ultrasound examinations with adequate image quality sufficient to determine if pathology is present or not. The emergency medical technicians’ and paramedics’ assessment correlates to some extent with an experienced reviewer and their findings are most reliable for the inclusion of a normal scan or inclusion of pleural effusion. Implementation could possibly impact the number of patients receiving correct prehospital treatment and optimal choice of receiving facility.

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“…POCUS seems to be accepted and available in Europe. Besides the more frequent use of POCUS compared with North America, the survey underlines that HEMS in Europe is mainly physician staffed which can explain the frequent use of POCUS (9,28). Some participants stated that POCUS is used in more than 30% of their patients indicating proper training in a wide range of applications.…”

Section: Discussionmentioning

confidence: 99%

“…European HEMS organizations should agree on common POCUS curriculum with an accepted standard that suits their needs. Competency is a key factor in successful clinical applications [4,28]. Using a Delphi methodology, Micheller et al de ned a total of ve modalities (cardiac, thoracic, FAST, aorta, and procedural), with 32 measured competencies and 72 sub competencies [29] as the basis for the needed curriculum.…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Ultrasound (POCUS) Practices in the Helicopter Emergency Medical Services in Europe

Hilbert-Carius

Struck

Rudolph³

et al. 2021

Preprint

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Background: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS. Methods: A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminders. Results: During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n=66) completed the survey. POCUS was available in 75% of the responding HEMS organizations when needed (56% always, and 19% occasionally). 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n=46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common used protocol. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations.Conclusions: The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are lacking in about two thirds of the European HEMS organizations.

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Prehospital point-of-care ultrasound: A transformative technology

Cited by 35 publications

References 52 publications

The Use of Handheld Ultrasound Devices in Emergency Medicine

The Use of Handheld Ultrasound Devices in Emergency Medicine

Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study

Point-of-Care Ultrasound (POCUS) Practices in the Helicopter Emergency Medical Services in Europe

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