Richard B the EMT Posted June 11, 2009 Posted June 11, 2009 The vehicle vibrations are an issue that is probably going to be addressed, otherwise, it is like artifact on an EKG, blocking what you are looking for, and, persuant to Murphy's Law, probably at the worst possible moment.
VentMedic Posted June 12, 2009 Posted June 12, 2009 http://www.911sono.com/ It has been used with great success in some services. It has helped speed the patient getting proper care rather than delaying proper care. This like the 12 lead do not add that much time on scene yet actually can improve patient care. Those that oppose seem to just want us to be taxi drivers rather than Pre Hospital Medical Professionals. LOL! I take it they haven't found a way to get reimbursed for it yet to pay off their purchase cost, training, retraining or maintenance fees. If you wish to make a tax deductible donation or obtain more information please contact Kathleen or Sabrina at 432-333-9377, 810 N. Dixie #201 Odessa, TX 79761. Usually a good assessment can determine which facility is best for the patient. I seriously doubt if most of these Paramedics pull our the US unless the BP is dropping which should clue in even the clueless that a higher level of care might be needed. There are also many things that won't be picked up by the EMS version of US assessment that could give a false sense of security that all is just fine when their physical assessment might be telling them something different. Again, it depends on whether you are ruling in or ruling out as it pertains to the accuracy and confidence factor of the findings. We could use the pulse ox and the ETCO2 as EMS "toys" that are under or over used as well as inappropriately and very much misunderstood rather than for the value both of these devices are intended. Some need to master basic (not as in EMT- assessment knowledge and skills before jumping in. Finding 3 organs on a normal 75 kg young male should not be very difficult and probably not very practical. Now if they were to do 100+ exams on a variety of patients just for practice, that might be more credible. Even 50 exams would be somewhat reasonable.
Neup Posted June 12, 2009 Posted June 12, 2009 The few studies I have found regarding the use of prehospital US seem to be positive. I think it would be a mistake to disregard the use of a new technology based on assumptions. Is there evidence of US causing significant delay in treatment or transportation?
FireMedic65 Posted June 12, 2009 Posted June 12, 2009 I all for the use of new technology and the education/training to go with it. No one said you had to do the ultrasound while in the moving ambulance, or even in the ambulance. They are pretty portable now a days and could be put in a compartment and taken out for training and when you have a call warranted for its use. I would be in line for this training, that's for sure.
scoobymedic96 Posted June 13, 2009 Author Posted June 13, 2009 Okay Yall here are some answers to the questions: There will be 3 US put on 3 different trucks in our county. I live in South Carolina. We are doing training at inservice and at our stations. Until we are checked off on it we are not allowed to use it. Only paramedics that have been checked off can use it. So, we will do as many exams as necessarry to get proficient with it. Our protocols havent changed. The US are portable and compact the picture is difficult at first because you constantly have to mess with the gain on it but i am sure we will all adjust to it. I am actually looking forward to becoming proficient with it. So is anyone using them besides us? I am sure there is some service. be safe and thankx for all your thoughts. I look forward to reading more.
VentMedic Posted June 13, 2009 Posted June 13, 2009 (edited) We trialed it about 4 years ago on the helicopter but found it did not make much difference since our destination was usually a trauma center from scene. As well, due to good response times and the nature of certain internal bleeding situations, there could be a chance some things would not be immediately recognizable. Thus, at the trauma center the patient may get a FAST scan as well as the possibility of a CT Scan before the surgeon takes the patient to the OR. We already got the doctors' attention by our assessments and relay of specific information that could get a surgeon put on notice. After weighing the costs, storage, maintenance, extra training and relatively no difference in what we would do that we probably would have done with or without the US, we decided to spend the money on safety items and update some older equipment. We also had so many other pieces of technology that we MUST know very well just to keep contracts for IFT with some hospitals. Questions for you: What have your supervisors said you would be looking for? What will this change in your care? Do you transport to a trauma center? Will it change your destination for a trauma if you don't "think" you see anything abnormal? I am not opposed to any new technology or skills. But, they must prove themselves to be of use in the prehospital environment and make a difference. We still have well over half of the EMS systems in this country that do not use ETCO2 monitors, 12-lead ECGs or CPAP. Edited June 13, 2009 by VentMedic
spenac Posted June 13, 2009 Posted June 13, 2009 In my neck of the woods there is no trauma hospital closer than a 1 hour flight. A FAST exam will help determine if we let bandaid ER deal with patient and ship or if we meet a plane or helicopter to take them. It is not hard to learn basic use of US. We are not doing extensive exams. If we wait till shock signs present delay to higher level can and will occur. For frontier medicine a definite plus. In the city where choice of hospital only changes transport 5-15 minutes MOI could justify just going to trauma hospital, so not a real need for spending the money.
VentMedic Posted June 13, 2009 Posted June 13, 2009 (edited) In my neck of the woods there is no trauma hospital closer than a 1 hour flight. A FAST exam will help determine if we let bandaid ER deal with patient and ship or if we meet a plane or helicopter to take them. It is not hard to learn basic use of US. We are not doing extensive exams. So you are viewing this as a definitive exam to "rule out" and that the patient is a band-aid case even though something made you use the US? We did not use it to downgrade care since we already had a good idea where we were taking the patient. We did not "rule out" but rather "ruled in" what we already suspected based on physical signs and MOI. If needed, we did have a couple of advanced procedures that could be used at scene or in flight. No it is not difficult to learn the knobs of an US just like all the other gadgets used in EMS. However, it does take some practice with different body types. My question to the OP is how the US was presented as to its purpose and what was being emphasized. Edited June 13, 2009 by VentMedic
HERBIE1 Posted June 13, 2009 Posted June 13, 2009 In my neck of the woods there is no trauma hospital closer than a 1 hour flight. A FAST exam will help determine if we let bandaid ER deal with patient and ship or if we meet a plane or helicopter to take them. It is not hard to learn basic use of US. We are not doing extensive exams. If we wait till shock signs present delay to higher level can and will occur. For frontier medicine a definite plus. In the city where choice of hospital only changes transport 5-15 minutes MOI could justify just going to trauma hospital, so not a real need for spending the money. I agree that the potential benefits would be more for a rural area and a long transport time. Problem is, I would hate to be the one who has to "decide" whether or not to transport to a Level 1 based on the findings of an US exam. I would think that like any skill, you would need to be pretty darn proficient in not only your technique to obtain a quality study, but your ability to interpret the results. Like was mentioned, that would mean using the device on multiple patients to keep you sharp. As you mentioned, by the time you could see fluid/air/blood on an US, wouldn't the person already be exhibiting signs of an internal injury and warrant a trip to a trauma center or you would already suspect such a problem based on MOI? I'm also am certainly no expert on US- I could barely make out pictures of my unborn kids much less an internal bleed. LOL
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