title: Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naive advanced paramedics: trialling a PHUS education programme.
abstract: OBJECTIVE
  This trial investigated whether advanced paramedics from a UK regional ambulance service have the ability to acquire and interpret diagnostic quality ultrasound images following a 2-day programme of education and training covering the fundamental aspects of lung ultrasound.
  
  
  METHODS
  The participants were tested using a two-part examination; assessing both their theoretical understanding of image interpretation and their practical ability to acquire diagnostic quality ultrasound images. The results obtained were subsequently compared with those obtained from expert physician sonographers.
  
  
  RESULTS
  The advanced paramedics demonstrated an overall accuracy in identifying the presence or absence of pneumothorax in M-mode clips of 0.94 (CI 0.86 to 0.99), compared with the experts who achieved 0.93 (CI 0.67 to 1.0). In two-dimensional mode, the advanced paramedics demonstrated an overall accuracy of 0.78 (CI 0.72 to 0.83), compared with the experts who achieved 0.76 (CI 0.62 to 0.86). In total, the advanced paramedics demonstrated an overall accuracy at identifying the presence or absence of pneumothorax in prerecorded video clip images of 0.82 (CI 0.77 to 0.86), in comparison with the expert users of 0.80 (CI 0.68 to 0.88). All of the advanced paramedics passed the objective structured clinical examination and achieved a practical standard considered by the examiners to be equivalent to that which would be expected from candidates enrolled on the thoracic module of the College of Emergency Medicine level 2 ultrasound programme.
  
  
  CONCLUSIONS
  This trial demonstrated that ultrasound-naive practitioners can achieve an acceptable standard of competency in a simulated environment in a relatively short period of time.
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, UK. michael.brooke@nwas.nhs.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Brooke
authors.forename: Julie
authors.initials: J
authors.lastname: Walton
authors.forename: Diane
authors.initials: D
authors.lastname: Scutt
authors.forename: Jim
authors.initials: J
authors.lastname: Connolly
authors.forename: Bob
authors.initials: B
authors.lastname: Jarman
mesh_terms: D002983:Clinical Competence; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D016544:Patient Simulation; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014465:Ultrasonics / Q000193:education*; D014463:Ultrasonography / Q000379:methods / Q000592:standards; D006113:United Kingdom