Is Ultrasound Useful For Your Friendly Neighborhood Paramedic?

 

By:  The Musing Medic (@TheMusingMedic)

 

 

Ultrasound Is Everywhere In Medicine, Should it Be In Our EMS Hands?

Ultrasound (US) has become a ubiquitous diagnostic tool used by a number of physicians from family medicine to trauma surgery to OB/GYN.  The modern US has become sleek and portable and reasonably priced.  There are even handheld US available for around $8,000.  Every physician practicing could have US capability in the palm of their hand.

 

So with US being so common, is it reasonable to think that US would be practical in the hands of your friendly neighborhood paramedics and medical flight crews?

 

The Big Two:  Training & Transport Time

 

According to the article Use of ultrasound by emergency medical services: a review, studies previously completed internationally and domestically show support for the use of US in select settings and situations.  Two of the major factors they touched on were training and transport time.  Training would be the least of the concerns in my mind.  With enough instruction, both didactic and clinical, most emergency responders should be able to accurately identify vital structures and anatomical regions in their normal state and identify varying pathologies when illness or injury occurs.  Really, it is knowing when and why to perform an US examination.

 

Access to definitive care for acute illness or injury is dictated by location. The idea of the “golden hour”in trauma or “time is muscle” in an Acute MI applies to many patients, whether they are five minutes or five hours from the nearest medical center

 

Does Urban Versus Rural Matter?

Ultrasound makes sense for both both urban/suburban responders and rural responders, but in different scenarios.  US examinations would be appropriate in both setting for detecting cardiac activity in cardiac arrests, evaluation of potential aortic aneurysms, pneumothorax or hemothorax in trauma patients as well as a FAST exam to check for internal hemorrhage.

 

But the urban/suburban setting allows for faster transport times.  That means that the US examination should not delay transport to the nearest appropriate medical center.  Regardless of how talented or skillful the emergency providers are, they simply do not possess all the necessary resources to manage an actively exsanguinating patient.  The onus is on the provider to make the appropriate judgment whether or not to perform an US examination.

 

Longer Transport Time Allows Easier US Examination

Practicing in the rural setting, more time during the transport can be dedicated to US examination and aiding in the formation of a differential diagnosis and treatment plan.  It should be mentioned that many emergency responders in rural settings have additional training and resources that urban/suburban providers do not, such as the ability to place chest tubes and administer blood products.  In these instances, immediate intervention is indicated in the field due to the time it would take to reach definitive care.

 

In The End It’s:  Location, Location, Location

What this entire topic comes down to is the same thing that real estate agents have been saying for years: “location, location, location”.  US has a place in the pre-hospital setting but a more limited utility in the urban or suburban setting.  Training has been developed and rolled out for pre-hospital providers so that is a good start.

 

I’m certainly in favor of US in the prehospital setting in theory, but more research is needed before I am willing to give this practice my full support.

 

Thoughts or comments?  Let me know beneath.

6 comments
TheMusingMedic
TheMusingMedic

Peterbonadonna,


Thank you for taking time to read the article and reach out.


I agree that indication alone should be enough to warrant the use of US. 


However, if the ED is in close proximity (5-10 mins) would it make sense to stay on scene to complete the US exam? Studies indicate that US can be preformed with success in a moving ambulance or helicopter. If this is truly the case, then I would say that location doesn't matter. But as I mentioned, I would prefer to see more research.


And I would gladly take you up on your offer to spend a day seeing how you utilize US in the field and even write a follow up to this article.


Thank you again and best wishes!


The Musing Medic

peterbonadonna
peterbonadonna

I agree with most of your statements but not with the location statement. Ultrasound can be used as quickly and as efficiently as a stethoscope and you would certainly never suggest that someone should only us a stethoscope if they were far from the hospital. Come spend a day with me, I can change your opinion.

In the end it's: Indication, Indication, Indication.

Www.paramedicultrasound.com

peterbonadonna
peterbonadonna

@DavidKashmer @peterbonadonna 

So far I'm fond of GE's Venue40, simple to use, large screen, great images but you are right, there is an ideal machine waiting to be developed for EMS.  I like some of your ideas. I will send them off to my contacts at GE and Philips

DavidKashmer
DavidKashmer

Putting US routinely into the hands of prehospital colleagues would open up a huge opportunity.  I wonder if it would be useful to change ultrasound hardware and software to make it more EMS friendly.  Meaning how would it look if ultrasound machines (eg the GE VSCAN that you indirectly referenced which costs about $4,000) became geared toward prehospital staff?  They could be weatherproofed or made more rugged or larger buttons and software that aids in diagnosis to make it more clear what's going on when you're bouncing around in the back of a rig or on the helicopter...

peterbonadonna
peterbonadonna

@DavidKashmer 

Simple and reliable Image and video transfer to the physicians would be needed.  In some areas it would be nice for realtime images to be evaluated from the ambulance as they are acquired.