Pre-hospital assessment with ultrasound

A Pilot Study Examining the Viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) Protocol

The Journal of Emergency Medicine: Volume 44, Issue 1 , Pages 142-149, January 2013

Prehospital ultrasound has been shown to aid in the diagnosis of multiple conditions that do not generally change prehospital management. On the other hand, the diagnoses of cardiac tamponade, tension pneumothorax, or cardiac standstill may directly impact patient resuscitation in the field. The authors wanted to determine if prehospital care providers can learn to acquire and recognise ultrasound images for several life-threatening conditions using the Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol.

This was a prospective, educational intervention pilot study at an urban fire department with integrated emergency medical services (EMS). 20 emergency medical technicians – paramedic with no prior ultrasonography training were enrolled into the study. Subjects underwent a 2-h training session on basic ultrasonography of the lungs and heart to evaluate for pneumothorax, pericardial effusion, and cardiac activity. Subjects were tested on image interpretation as well as image acquisition skills. Two bedside ultrasound-trained emergency physicians scored images for adequacy. Image interpretation testing was performed using pre-obtained ultrasound clips containing normal and abnormal images.

All subjects appropriately identified the pleural line, and 19 of 20 paramedics achieved a Cardiac Ultrasound Structural Assessment Scale score of ≥4. For the image interpretation phase, the mean PAUSE protocol video test score was 9.1 out of a possible 10 (95% confidence interval 8.6–9.6).

The authors found that paramedics were able to perform the PAUSE protocol and recognise the presence of pneumothorax, pericardial effusion, and cardiac standstill. The PAUSE protocol may potentially be useful in rapidly detecting specific life-threatening pathology in the prehospital environment, and warrants further study in existing EMS systems.

http://www.jem-journal.com/article/S0736-4679(12)00253-3/abstract?elsca1=etoc&elsca2=email&elsca3=0736-4679_201301_44_1&elsca4=emergency_medicine

One thought on “Pre-hospital assessment with ultrasound

  1. Sounds great.

    As the units get cheaper, prehospital U/S feels closer and closer.

    Optical nerve sheath for ICP rises, lungs for pneuo and CCF, IVC for volume status, heart for wall motion abnormality, effusion/tamponade and cardiac standstill, FAST exams, IV placement. I can barely think of any other piece of kit that would be more useful.

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