The Ultrasound Identification of Simulated Long Bone Fractures by Prehospital Providers

Abstract

Using portable ultrasound, EMTs correctly detected the presence or absence of simulated long bone fractures with a high degree of sensitivity and specificity. Future studies may evaluate the ability of other groups to use ultrasound to assist in the diagnosis of fractures and examine the clinical impact of this skill in environments where conventional imaging modalities are limited or unavailable.

Educational standards for training paramedics in ultrasound: a scoping review

“…Assessment for this study was conducted 6-weeks following initial training and involved a written test with an average score of 82% pre-training versus 71% when performed 12-months later. Regarding the performance of the paramedics, of the seven articles that reported on accuracy measures, sensitivity ranged from 67 to 97.5%, and specificity from 56 to 97% [7, 8, 17–19, 23, 25]. The lowest ranges related to a study in mass casualty incidents [19].…”

“…POCUS curricula for long bone fracture recognition was reported by one study [17]. A fracture simulation model was composed of five different types of mechanically fractured bare turkey leg bone.…”

“…Paramedic participants received a 2-min standard orientation and training session prior to evaluation. Across all fracture patterns the paramedics achieved an overall detection sensitivity of 97.5% and specificity of 95.0% [17]. …”

“…ParamedicsAdvanced paramedics, US naiveDetermine if advanced paramedics can be trained to acquire and interpret quality ultrasound imagesPneumothoraxPre-recorded video clipsProspective observational cohort studyCappa et al 2015 Arizona [28]Not reportedED nurses and paramedicsDetermine if a program to train nurses and paramedics to place USGIV’s in the ED decreases the use of central lines.Peripheral Intravenous accessNot reportedCombined retrospective and prospective observational studyChin et al 2013USA [16] n  = 20 Firefighter paramedicsUS naiveDetermine if EMTs can be trained using Pre-hospital Assessment with US for Emergencies (PAUSE) protocolPneumothorax, pericardial effusion & cardiac standstillHealthy modelsProspective educational intervention studyHeegaard et al 2004 USA [7] n  = 10. Flight nurses & paramedics>5 years clinical experienceDevelop a training program for air medical clinicians using focused POCUS examinations and assess competencies 1 year later.FAST in medical & trauma casesReal patientsProspective observational studyHeiner & McArthur 2010 USA [17] n  = 20. EMTsUS naiveStudy ability of EMTs to be trained to recognize presence of fractures using portable POCUSLong bone fracturesSimulation model on turkey leg boneProspective observational studyKnapp et al 2012 USA [22] n  = 90 Paramedics 70 EMT-Ps and 20 EMT-IsParamedic and Intermediate EMT providers.…”

“…This included (1) a written test and (2) a practical imaging test. These same tests were administered 1 year from the initiation of the program.US for pericardial effusion: sensitivity & specificity 100% (1/86 cases positive), no false negative or false positive cardiac US Abdominal trauma cases: sensitivity 60%, and specificity 93%.Immediately post-course questionnaire score of 82% vs. percentage when administered 1 year later - 71%Heiner & McArthur 2010 [17]Didactic & practicalApplication & interpretation2- min orientation/trainingParticipants received a 2-min standardized orientation and training session ensuring familiarization with examination of the semi-opaque fracture model. They then sonographically evaluated the 5 completely opaque models.Sensitivity of 97.5% and specificity of 95.0% across 5 different fracture patterns.Knapp et al 2012 [22]Didactic & practicalApplication & interpretation1 h online home based study program followed by 4 h training programA four- hour training program that consisted of a didactic lecture, practice scanning, and testing scenarios.…”