Portable ultrasound in pre-hospital emergencies: a feasibility study.
BACKGROUND
Ultrasound plays a central role in the evaluation of both trauma and medical emergencies. The development of portable sonography devices could extent its application into the pre-hospital arena. The aim of our study was to evaluate feasibility of pre-hospital ultrasound in the Norwegian Air Rescue setting.


METHODS
During a 3-month period, we conducted a prospective study using sonography in pre-hospital patient management. All examinations were carried out by the same ultrasound-certified physician using a Primedic Handyscan in a standardized focused protocol for abdominal and lung sonography and a subcostal 2-chamber long axis view. Inclusion criteria were abdominal/thoracic and obstetric trauma, circulatory/respiratory compromise, pulseless electric activity (PEA) in cardiac arrest, acute abdomen and monitoring during transport. Allowed examination time was restricted to 3 min on the scene. The patient's gender, age, symptoms, trauma mechanism, quality of visualization and diagnose made were recorded. Pre-hospital results were compared with in-hospital findings.


RESULTS
Thirty-eight patients were entered into the study. Three patients had to be excluded due to technical difficulties. Nineteen medical, 15 traumas and 1 obstetric patient were included. Good visualization was obtained in 74% (n= 26), moderate in 26% (n = 9). Median examination time was 2.5 min (range 1-3 min). Nine patients (26%) showed positive sonography findings. Sensitivity was 90%, specificity 96%. Diagnostic usefulness was high in undetermined cardiac arrest and hypotension and massive hematoperitoneum.


CONCLUSIONS
Pre-hospital ultrasound when applied by an proficient examiner using a goal-directed, time sensitive protocol is feasible, does not delay patient management and provides diagnostic and therapeutic benefit. Further studies are warranted to identify the exact indications and role of pre-hospital sonography.
Busch
M
M
Norwegian Air Ambulance (NLA) Base, Stavanger, Norway. Micheal.Busch@rikshospitalet.no
D000293:Adolescent; D000328:Adult; D000368:Aged; D004630:Emergencies; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008297:Male; D008875:Middle Aged; D009664:Norway; D011247:Pregnancy; D011446:Prospective Studies; D018635:Rescue Work; D014463:Ultrasonography / Q000295:instrumentation*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy