Prehospital Ultrasound by Paramedics: Results of Field Trial

Abstract

Objectives: The objective was to determine if 9-1-1 paramedics trained in ultrasound (US) could adequately perform and interpret the Focused Assessment Sonography in Trauma (FAST) and the abdominal aortic (AA) exams in the prehospital care environment.Methods: Paramedics at two emergency medical services (EMS) agencies received a 6-hour training program in US with ongoing refresher education. Paramedics collected US in the field using a prospective convenience methodology. All US were performed in the ambulance without scene delay. US exams were reviewed in a blinded fashion by an emergency sonographer physician overreader (PO).Results: A total of 104 patients had an US performed between January 1, 2008, and January 1, 2009. Twenty AA exams were performed and all were interpreted as negative by the paramedics and the PO. Paramedics were unable to obtain adequate images in 7.7% (8 ⁄ 104) of the patients. Eighty-four patients had the FAST exam performed. Six exams (6 ⁄ 84, 7.1%) were read as positive for free intraperitoneal ⁄ pericardial fluid by both the paramedics and the PO. FAST and AA US exam interpretation by the paramedics had a 100% proportion of agreement with the PO.Conclusions: This pilot study shows that with close supervision, paramedics can adequately obtain and interpret prehospital FAST and AA US images under protocol. These results support a growing body of literature that indicates US may be feasible and useful in the prehospital setting. ACADEMIC EMERGENCY MEDICINE2010; 17:624-630 ª 2010 by the Society for Academic Emergency MedicineKeywords: prehospital ultrasound, paramedic ultrasound, trauma care, and ultrasound P oint-of-care (POC) ultrasound (US) has significantly increased in use over the past 20 years. [1][2][3] Multiple studies have shown the efficacy and efficiency of POC US. Some studies have demonstrated improved morbidity and mortality outcomes.3-5 The use of POC US in the prehospital setting is a relatively new application of this medical technology. Small studies have shown utility in military, ground, and helicopter emergency medical services (EMS) in both Europe and the United States. [5][6][7][8][9][10][11][12][13][14][15][16][17] These studies have largely concentrated on US use for trauma evaluation and involve the application of the Focused Assessment Sonography for Trauma (FAST) or an extended FAST examination. Prehospital US use has been more fully described in Germany, France, and Italy than in the United States.

Paramedic Performed Focused Assesment with Sonography in Trauma (FAST) in the Emergency Department

“…There was one study in the English literature about paramedicperformed FAST, but it was designed in the prehospital area and for prehospital triage. [26] We found that our results were well correlated with this study as well. A literature search showed that USG performed by healthcare personnel other than doctors, such as nurses and paramedics, was accurate in other areas such as intravenous cannula insertion, echocardiography, abdominal aortic aneurysm detection, and obstetric USG.…”

Accuracy of Ultrasound for Diagnosis of Femur Bone Fractures in Traumatic Patients

“…During this period, focus has swerved toward using ultrasound in the ED and in the pre-hospital setting [16,17]. The E-FAST (Extended Focused Assessment Sonography in Trauma) is affirmed as well as using in patients with major trauma [18].…”

Out of hospital point of care ultrasound: current use models and future directions

“…With thorough training and close supervision, medics can adequately obtain and interpret prehospital ultrasound images [23]. A simulation trial demonstrated that ultrasound-naive practitioners were able to achieve an acceptable standard of competency in a relatively short period of time for both acquisition and interpretation of images [24].…”