Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services.
BACKGROUND
In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images.


METHODS
We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties. Participants completed a pre-test of sonographic imaging of normal findings and three pathologic findings: pericardial effusion, pneumothorax, and cardiac standstill. A focused one-hour lecture on emergency US imaging followed. Post-tests were given to all EMS providers immediately following the lecture and to a subgroup one week later.


RESULTS
We enrolled 57 prehospital providers (19 EMT-B students, 16 EMT-P students, 18 certified EMT-B, and 4 certified EMT-P). The mean pre-test score was 65.2%±12.7% with mean immediate post-test score of 91.1%±7.9% (95% CI [22%-30%], p<0.001). Scores significantly improved for all three pathologic findings. Nineteen subjects took the one-week post-test. Their mean score remained significantly higher: pre-test 65.8%±10.7%; immediate post-test 90.5%±7.0% (95% CI [19%-31%], p<0.001), one-week post-test 93.1%±8.3% (95% CI [21%-34%], p<0.001).


CONCLUSIONS
Using a small sample of EMS providers and students, this study shows the potential feasibility for educating prehospital providers to accurately identify images of pericardial effusion, pneumothorax, and cardiac standstill after a focused lecture.
Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California ; Kaiser Permanente Santa Clara Medical Center, Department of Emergency Medicine, Santa Clara, California.
Sundeep R
SR
Bhat
Emergency Medicine Physicians, Department of Emergency Medicine, Mecklenberg, North Carolina.
David A
DA
Johnson
Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California.
Jessica E
JE
Pierog
Kaiser Permanente San Francisco Medical Center, Department of Emergency Medicine, San Francisco, California.
Brita E
BE
Zaia
Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California.
Sarah R
SR
Williams
Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California.
Laleh
L
Gharahbaghian
D000328:Adult; D002140:California; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult