title: Use of prehospital ultrasound in North America: a survey of emergency medical services medical directors.
abstract: BACKGROUND
  Advances in ultrasound imaging technology have made it more accessible to prehospital providers. Little is known about how ultrasound is being used in the prehospital environment and we suspect that it is not widely used in North America at this time. We believe that EMS system characteristics such as provider training, system size, population served, and type of transport will be associated with use or non-use of ultrasound. Our study objective was to describe the current use of prehospital ultrasound in North America.
  
  
  METHODS
  This study was a cross-sectional survey distributed to EMS directors on the National Association of EMS Physicians (NAEMSP) mailing list. Respondents had the option to complete a paper or electronic survey.
  
  
  RESULTS
  Of the 755 deliverable surveys we received 255 responses from across Canada and the United states for an overall response rate of 30%. Of respondents, 4.1% of EMS systems (95% CI 1.9, 6.3) reported currently using ultrasound and an additional 21.7% (95% CI 17, 26.4) are considering implementing ultrasound. EMS services using ultrasound have a higher proportion of physicians (p < 0.001) as their highest trained prehospital providers when compared to the survey group as a whole. The most commonly cited current and projected applications are Focused Abdominal Sonography for Trauma (FAST) and assessment of pulseless electrical activity (PEA) arrest. The cost of equipment and training are the most significant barriers to implementation of ultrasound. Most medical directors want evidence that prehospital ultrasound improves patient outcomes prior to implementation.
  
  
  CONCLUSIONS
  Prehospital ultrasound is infrequently used in North America and there are a number of barriers to its implementation, including costs of equipment and training and limited evidence demonstrating improved outcomes. A research agenda for prehospital ultrasound should focus on patient-important outcomes such as morbidity and mortality. Two commonly used indications that could be a focus of standardized training programs are the FAST exam, and assessment of PEA arrest.
authors.affiliation: University of Calgary MD program, #108 1990 West 6 Avenue, Vancouver, BC V6J 4V4, Canada. jataylo@ucalgary.ca.
authors.forename: John
authors.initials: J
authors.lastname: Taylor
authors.forename: Kyle
authors.initials: K
authors.lastname: McLaughlin
authors.forename: Andrew
authors.initials: A
authors.lastname: McRae
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.forename: Andrew
authors.initials: A
authors.lastname: Anton
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D002170:Canada; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D019719:Diagnostic Equipment / Q000191:economics; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006323:Heart Arrest / Q000000981:diagnostic imaging; D006801:Humans; D008486:Physician Executives; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014481:United States