Prehospital ultrasound

[fiznat]

JEMS has an article this month about the potential for EMS utilization of prehospital ultrasound (http://www.jems.com/article/patient-care/ultrasound-applications-ems). The article argues that ultrasound can be useful in the diagnosis of cardiac tamponade, pneumothorax, ABD trauma/bleeding, pulmonary embolism, and cardiac arrest, as well as helpful in cases of difficult IV access.

The article refers to some (yet unpublished) research that says prehospital ultrasound can be useful in as much as 1 in 6 EMS calls. My personal feeling is that number seems to be a bit overstated. What do people here think? Do we need ultrasound? Is it a legitimate expansion of necessary prehospital care, or just an opportunity to sell ultrasound machines to an already technology-happy industry?

[DartmouthDave]

Hello,

1 in 6 calls. I agree that sounds suspect.

Sure, who funded the study...........

I wonder.

Next, we will see JEMS awash with glossy add for ultra sound machines.

Cheers

Edited September 5, 2010 by DartmouthDave

[HERBIE1]

I recall this topic discussed before, but..

I can see the value in such a tool in very specific situations. In a rural area where access to primary care in limited, and transport times are measured in hours. It could potentially help rule out a more serious situation that would require air transport vs ground, it could mobilize hospital staff needed for a surgical case, etc. Obviously the cost is a huge factor, and I question how many smaller, rural areas could afford it without some subsidy or grant, maybe from a hospital.

[spenac]

I think the number is highly overstated as well.

As to value yes it would be great for all services city, rural, frontier. In the city might help determine the appropriate hospital to go to.

It does not delay care or transport and like the 12 lead could actually help patients get appropriate care quicker.

[FireMedic65]

Do we "need" it... no, probably not. Would it be nice? Yes it would. I am a firm believer that progress is good. Learning how to use new tools is a good thing. When it comes time for medical directors to look at EMS systems, they can look at all this stuff "wow.. they use this? they are trained in that?"

But if you are happy with minimal medicine and little skills, that's fine. I for one, want more.

[HERBIE1]

Do we "need" it... no, probably not. Would it be nice? Yes it would. I am a firm believer that progress is good. Learning how to use new tools is a good thing. When it comes time for medical directors to look at EMS systems, they can look at all this stuff "wow.. they use this? they are trained in that?"

But if you are happy with minimal medicine and little skills, that's fine. I for one, want more.

Hey, we could be trained in all types of procedures and equipment, but there is a fundamental issue here. The entire medical profession needs to get on board with the idea and support not only this idea, but the whole notion of prehospital care. We have an opportunity to advance the profession. If we further integrate EMS into primary care, then we would fundamentally change the way care is delivered. Would it be cheaper, more cost effective, more efficient to provide things like ultrasound, inoculations, wound checks, or other home health care? Maybe, maybe not, but it would be a huge departure from the original intent of EMS. Yes, we SHOULD evolve, but how far?

I'm not necessarily against the idea, just wondering where this could lead.

[FireMedic65]

I am all for evolving.

[Doczilla]

If you include ultrasound guided IV insertion, I would say the number is about accurate IF you used it for every IV, but most here would probably agree that's not necessary most o the time. I agree that it is overstated for most other indications. EFAST for trauma would have application for the critically ill trauma patient if they have hypotension to elicit the cause of the hypotension (hypovolemia, pericardial tamponade, or tension pneumo?). In a remote setting, with prolonged transport times, it may help the medic determine which mode of transport or destination would be most appropriate in a trauma patient without outward sign of serious injury (like hypotension, evisceration, etc.). Volume status in a patient with abnormal vitals might be helpful. Diagnosing appendicitis or cholecystitis or kidney stones in the field would not benefit the patient, significantly alter transport destinations, decrease time to OR, or change treatment. Same thing with diagnosis of fractures.

We taught this at the CAP Lab one year. It generated a lot more interest than we thought.

'zilla

[JPINFV]

Doczilla,

Do you think that there are enough trauma patients who would have a postive FAST exam and are not already headed towards a trauma center for ultrasound to be useful? That's the problem main problem I see with prehospital ultrasound. In most places a positive result won't change anything since the crew is already heading for the trauma center.

[Kiwiology]

I am not a surgical registrar or OB .... so I don't need ultrasound