Pre-hospital assessment with ultrasound in emergencies: implementation in the field.
BACKGROUND
Point-of-care ultrasound (US) is a proven diagnostic imaging tool in the emergency department (ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the field and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients.


METHODS
We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest.


RESULTS
Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making (89%, 95%CI 67%-99%). Paramedics accurately recorded 17 cases of cardiac activity (100%, 95%CI 84%-100%) and 2 cases of cardiac standstill (100%, 95%CI 22%-100%).


CONCLUSIONS
Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.
Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Kevin P
KP
Rooney
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
Sari
S
Lahham
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
Shadi
S
Lahham
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
Craig L
CL
Anderson
Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA.
Bryan
B
Bledsoe
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
Bryan
B
Sloane
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
Linda
L
Joseph
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
Megan B
MB
Osborn
Emergency Medicine, University of California, Irvine, Orange, California 92868, USA.
John C
JC
Fox
Cardiac ultrasound; Emergency ultrasound; Prehospital ultrasound