Ultrasound in pre-hospital trauma care

Abstract

Pre-hospital medicine is developing rapidly. Increasingly, specialist pre-hospital medical practitioners are working in this environment and paramedics are advancing their skill base. Tools traditionally associated with hospital care are now used pre-hospital to improve diagnosis and intervention. In this paper, we assess the developing role of ultrasound in improving trauma care in the pre-hospital arena. Focused ultrasound is used to facilitate early diagnosis of pneumothorax and intraperitoneal/pericardial haemorrhage in trauma victims. Ultrasound may have a role in assessing the circulating blood volume, fracture diagnosis and triage in mass casualty scenarios. Information obtained using ultrasound may change diagnoses and consequently alter therapy, as well as patient disposition by highlighting injuries not identified on physical examination. Receiving hospitals can be alerted to injuries requiring intervention upon arrival. Ultrasound is also used to reduce complications and improve performance in numerous procedures such as obtaining vascular and intra-osseous access, paracentesis and tracheal tube placement. There is emerging evidence that ultrasound may be used safely pre-hospital without increasing on-scene times and with results comparable to use in hospital.

New International Guidelines and Consensus on the Use of Lung Ultrasound

“…Imaging is essential when dealing with critically ill patients, and LUS 148 , 216 is a remarkably versatile 217 imaging technique which, thanks to portable US devices, can be effectively performed before reaching organized medical facilities or during transport. 140 , 218 …”

“…Imaging is essential when dealing with critically ill patients, and LUS 148,216 is a remarkably versatile 217 imaging technique which, thanks to portable US devices, can be effectively performed before reaching organized medical facilities or during transport. 140,218 In the pre-hospital emergency setting, LUS can provide immediate yes/no diagnostic answers, as well as in-depth diagnostic evaluations, enabling or facilitating patient decision-making and management, and optimizing the allocation of resources. 219,220 The most common applications of LUS on the field are thoracic injuries and respiratory failure.…”

Emergency care practitioners’ views on the use of ultrasound in pre-hospital acute care settings

“…In these studies, researchers found similar sensitivity and specificity in diagnoses compared to diagnoses made in in-hospital emergency department settings. 5,10,11 Another interesting study, this time with physicians who scanned 302 patients in an out-of-hospital setting, reported improvements in diagnostic confidence and accuracy with the use of ultrasound. 5 Our participants concurred, expressing that an improved diagnosis (as a result of ultrasound) may lead to changes in their triage, treatment, and management strategies.…”

Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis

“…Their pooled results also suffered with considerable heterogeneity [38][39][40][41][42]. Previously published reviews involving pre-hospital thoracic POCUS for pneumothorax are exclusively narrative in nature [43][44][45][46][47][48]. Authors cite a paucity in suitable evidence at the time of writing as the reason why they did not conduct quantitative analysis.…”