title: Remote just-in-time telementored trauma ultrasound: a double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display.
abstract: BACKGROUND
  Remote-telementored ultrasound involves novice examiners being remotely guided by experts using informatic-technologies. However, requiring a novice to perform ultrasound is a cognitively demanding task exacerbated by unfamiliarity with ultrasound-machine controls. We incorporated a randomized evaluation of using remote control of the ultrasound functionality (knobology) within a study in which the images generated by distant naive examiners were viewed on an ultrasound graphic user interface (GUI) display viewed on laptop computers by mentors in different cities.
  
  
  METHODS
  Fire-fighters in Edmonton (101) were remotely mentored from Calgary (n = 65), Nanaimo (n = 19), and Memphis (n = 17) to examine an ultrasound phantom randomized to contain free fluid or not. Remote mentors (2 surgeons, 1 internist, and 1 ED physician) were randomly assigned to use GUI knobology control during mentoring (GUIK+/GUIK-).
  
  
  RESULTS
  Remote-telementored ultrasound was feasible in all cases. Overall accuracy for fluid detection was 97% (confidence interval = 91 to 99%) with 3 false negatives (FNs). Positive/negative likelihood ratios were infinity/0.0625. One FN occurred with the GUIK+ and 2 without (GUIK-). There were no statistical test performance differences in either group (GUIK+ and GUIK-).
  
  
  CONCLUSIONS
  Ultrasound-naive 1st responders can be remotely mentored with high accuracy, although providing basic remote control of the knobology did not affect outcomes.
authors.affiliation: Regional Trauma Services, University of Calgary, 1403 29 St NW Calgary, Alberta, T2N 2T9, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Canadian Forces Medical Services, Canada. Electronic address: andyyykirk@gmail.com.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Edmonton Fire Department, Edmonton, Alberta, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: McKee
authors.affiliation: Innovative Trauma Care, San Antonio, Texas, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: McKee
authors.affiliation: Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Ma
authors.affiliation: Regional Trauma Services, University of Calgary, 1403 29 St NW Calgary, Alberta, T2N 2T9, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Paul B
authors.initials: PB
authors.lastname: McBeth
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Department of Emergency Medicine, Nanaimo Regional General Hospital, Nanaimo, British Columbia.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Wurster
authors.affiliation: City of Edmonton, Edmonton, Alberta, Canada.
authors.forename: Robbie
authors.initials: R
authors.lastname: Parfitt
authors.affiliation: Regional Trauma Services, University of Calgary, 1403 29 St NW Calgary, Alberta, T2N 2T9, Canada; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Summit Services, Calgary, Alberta, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Oberg
authors.affiliation: Edmonton Fire Department, Edmonton, Alberta, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Sevcik
authors.affiliation: Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Hamilton
mesh_terms: D001826:Body Fluids / Q000000981:diagnostic imaging*; D016001:Confidence Intervals; D004311:Double-Blind Method; D004632:Emergency Medical Services / Q000379:methods*; D061388:Firefighters / Q000193:education*; D006801:Humans; D008348:Manikins; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods; D013647:Task Performance and Analysis; D017216:Telemedicine / Q000379:methods*; D014463:Ultrasonography / Q000295:instrumentation*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy
keywords: Remote education; Resuscitation; Telemedicine; Telesonography; Ultrasound