A simulator-based study of in-flight auscultation.
BACKGROUND
The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft.


METHODS
Sounds were mimicked using a mannequin-based simulator SimMan. Five practitioners examined the mannequin during a fly, with a variety of abnormalities as follows: crackles, wheezing, right and left lung silence, as well as systolic, diastolic, and Austin-Flint murmur. The comparison for diagnosis assessed (correct or wrong) between using the electronic and conventional stethoscopes were performed as a McNemar test.


RESULTS
A total of 70 evaluations were performed. For cardiac sounds, diagnosis was right in 0/15 and 4/15 auscultations, respectively, with conventional and electronic stethoscopes (McNemar test, P = 0.13). For lung sounds, right diagnosis was found with conventional stethoscope in 10/20 auscultations versus 18/20 with electronic stethoscope (P = 0.013).


CONCLUSIONS
Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.
From the Emergency Medical Service (J.P.T., D.J., C.E.A.), Fire Brigade of Paris, 1 Place Jules Renard; Department of Intensive Care (N.L., P.C., S.D., B.D., Y.A.), Military Hospital Val-de-Grâce, Paris; Department of Intensive Care, Military Hospital Val-de-Grâce, Paris; Emergency Medical Service, Fire Brigade of Paris, 1 Place Jules Renard; Emergency Medical Service (K.T.), Melun, 11 Rue Freteau De Peny, Melun, France.
Jean-Pierre
JP
Tourtier
Nicolas
N
Libert
Patrick
P
Clapson
Stéphane
S
Dubourdieu
Daniel
D
Jost
Karim
K
Tazarourte
Cécil-Emmanuel
CE
Astaud
Bruno
B
Debien
Yves
Y
Auroy
D000328:Adult; D017732:Air Ambulances; D001314:Auscultation / Q000295:instrumentation*; D003198:Computer Simulation; D005260:Female; D006321:Heart / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008348:Manikins; D008875:Middle Aged; D009624:Noise, Transportation; D019023:Stethoscopes; D014732:Vibration