The Use of FAST Scan by Paramedics in Mass-casualty Incidents: A Simulation Study

Abstract

In this simulation study, paramedics had difficulty performing FAST scans with a high degree of accuracy. However, they were more apt to call a patient positive, limiting the likelihood for false-negative triage.

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].…”

“…5 ED doctors & 4 paramedics (403 participants total trained from 2003 to 06)US naive. US training day then performed on scene.Evaluate effectiveness of new training course for prehospital FAST (P-FAST)FAST in trauma patientsHealthy models, models with positive FAST (ascites or peritoneal dialysis), and real patientsProspective, multi-centre studyWest et al 2014 USA [19] n  = 9 paramedics (10 enrolled but one pulled out on examination day)Paramedics with field experience but US naïveEvaluate the accuracy andtime taken to perform multiple FAST exams in a simulated MCI setting.FAST in trauma patients during MCIHealthy models and models with positive FAST (peritoneal dialysis patients)Single-blinded RCTVitto et al 2015USA [25] n  = 15 flight nurses and paramedics. US naïveEvaluate the ability of flight nurses and paramedics to learn and retain U/S for use during flight and ground transport.Not ReportedHealthy models and US simulations using US simulatorProspective observational cohort study …”

“…Computerized abdominal tomography (CAT) was ordered as desired by general surgeon consultants and evaluated by radiologists who were blind to the study. The gold standard for the presence of free fluid was the official radiologist reports of USG and CAT.Paramedic performed FAST: sensitivity 84.62%, specificity 97.37%West et al 2014 [19]Didactic & practicalApplication & interpretation4-h course involving both lecture and hands-on trainingTraining consisted of a 4-h course taught by a certified ultra-sonographer and board certified emergency physician. The course involved both lecture and hands on portions with access and training on both control and positives.…”

Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan

“…30,31 On the other hand, ultrasound has some limitations as well as a very broad range of reported sensitivity and specificity for detecting free fluid and injuries in patients with major trauma. 32 In a MCI simulation study looking for free abdominal fluid detected by Focused assessment with sonography in trauma (FAST, also known as focused abdominal sonography for trauma), the authors observed a false-positive (5overtriage) rate of 59% and a sensitivity of 67%.…”

“…32 In a MCI simulation study looking for free abdominal fluid detected by Focused assessment with sonography in trauma (FAST, also known as focused abdominal sonography for trauma), the authors observed a false-positive (5overtriage) rate of 59% and a sensitivity of 67%. 31 The average time needed for a FAST examination was about 2 min.…”