Prehospital ultrasound

[basejump]

As great of a tool this could be, I don 't see it happening anytime soon due to the cost. Thanks for the great topic.

[ERDoc]

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

I'm not either but I sure do use it in my practice. Don't throw it away before you see how it can be used to help the pts.

[speedygodzilla]

Have to admit I didn't read the whole article but it did make me think of the possibilities. Like FireMedic65 said earlier

"Do we 'need' it... no, probably not. Would it be nice? Yes it would." I agree. I could think of calls it would be nice for but they are far and few in between. I didn't see a cost but I am guessing it isn't cheap.

[Richard B the EMT]

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?

A good question.

1 in 6 calls. I agree that sounds suspect. Sure, who funded the study...........Next, we will see JEMS awash with glossy add for ultra sound machines.

Agreed.

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.

A good point, which you posted before me.

Yes, we SHOULD evolve, but how far? I'm not necessarily against the idea, just wondering where this could lead.

Another good question.

As great of a tool this could be, I don 't see it happening anytime soon due to the cost.

I think many said that when they introduced First Responder and BLS Defibrillator protocols, and local and state DoH started adding the devices to mandatory ambulance equipment lists. I have heard of, but cannot at this time provide documentation, of a decent number of "saves" with the devices, with no clue if they were just "saves" or Quality Of Life Saves".

[jbowman]

JEMS has an article this month about the potential for EMS utilization of prehospital ultrasound (http://www.jems.com/...pplications-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The article refers to some (yet unpublished) research that says prehospital ultrasound can be useful in as much as 1 in 6 EMS calls.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?

The unpublished study is the one that states it was approximately 1 in 10 calls that we used it on. That is the current study going on at Keller. The 1 in 6 is from a study in the European Journal of Emergency Medicine by Hans Xavier. It is published.

Hans Xaver Hoyera, Et. Al. "Prehospital Ultrasound in Emergency Medicine: Incidence, Feasibility, Indications and Diagnoses." European Journal of Emergency Medicine 00.00 (2010). Lippincott Williams & Wilkins Total Access Collection. Web. 5 Apr. 2010.

Here is the conclusion.

"Conclusion: Ultrasound is the only imaging modality and a

useful diagnostic tool in prehospital emergency medicine.

Helpful information can be provided in at least one of six

cases (or even more) in a trauma-dominated collective.

Examination time is short; it will not significantly delay

medical care. Ultrasound examination could improve triage

in cases of more than one patient in disaster medicine,

but further studies are necessary. European Journal of

Emergency Medicine 17:254–259 c 2010 Wolters Kluwer

Health | Lippincott Williams & Wilkins."

I know one in six may sound like a lot. And for some services it probably is a lot. We only found it useful in about one in ten calls, and that's with doing more types of exams than Dr. Xavier did. Take it as you wish. Most paramedics think ultrasound is a waste of time. I admit I was highly skeptical of it at first and only got into it because of a school project. But once you start using it you will see how incredibly useful it is. You think 12 leads are important? Ultrasound can do 20x as much and in the same time period. If you are ever in Texas I welcome you to come by Keller and check it out for yourself.

To those that think JEMS, or I for that matter got paid by an ultrasound company. Two words, "I wish". ;-)

For anyone wanting more information or what not, here is my email

bowmanjp@livemail.uthscsa.edu

Have a great day everybody and be safe out there.

Jason Bowman

[spenac]

The unpublished study is the one that states it was approximately 1 in 10 calls that we used it on. That is the current study going on at Keller. The 1 in 6 is from a study in the European Journal of Emergency Medicine by Hans Xavier. It is published.

Hans Xaver Hoyera, Et. Al. "Prehospital Ultrasound in Emergency Medicine: Incidence, Feasibility, Indications and Diagnoses." European Journal of Emergency Medicine 00.00 (2010). Lippincott Williams & Wilkins Total Access Collection. Web. 5 Apr. 2010.

Here is the conclusion.

"Conclusion: Ultrasound is the only imaging modality and a

useful diagnostic tool in prehospital emergency medicine.

Helpful information can be provided in at least one of six

cases (or even more) in a trauma-dominated collective.

Examination time is short; it will not significantly delay

medical care. Ultrasound examination could improve triage

in cases of more than one patient in disaster medicine,

but further studies are necessary. European Journal of

Emergency Medicine 17:254–259 c 2010 Wolters Kluwer

Health | Lippincott Williams & Wilkins."

I know one in six may sound like a lot. And for some services it probably is a lot. We only found it useful in about one in ten calls, and that's with doing more types of exams than Dr. Xavier did. Take it as you wish. Most paramedics think ultrasound is a waste of time. I admit I was highly skeptical of it at first and only got into it because of a school project. But once you start using it you will see how incredibly useful it is. You think 12 leads are important? Ultrasound can do 20x as much and in the same time period. If you are ever in Texas I welcome you to come by Keller and check it out for yourself.

To those that think JEMS, or I for that matter got paid by an ultrasound company. Two words, "I wish". ;-)

For anyone wanting more information or what not, here is my email

bowmanjp@livemail.uthscsa.edu

Have a great day everybody and be safe out there.

Jason Bowman

Thanks for the information. I have wanted to ad it for many years but my service has never been willing to spend the money.

[uglyEMT]

Want to hear soemthing funny? Here in NJ we have been using it over a year LOL The ALS rigs have them but I have seen it used once for a PE patient. I dont know if the medics just dont want to use them or maybe they feel its unnecessary but they have them if they want to use it.

I guess as more and more new medics come through school, if the school had them using them, it will get used more. Just like at the BLS level we were taught BGL yet the older EMTs on my squad years ago were not I take a BGL on all my patients yet the others just do the other vitals and skip the BGL.

As times change we adapt I guess.

[HERBIE1]

Want to hear soemthing funny? Here in NJ we have been using it over a year LOL The ALS rigs have them but I have seen it used once for a PE patient. I dont know if the medics just dont want to use them or maybe they feel its unnecessary but they have them if they want to use it.

I guess as more and more new medics come through school, if the school had them using them, it will get used more. Just like at the BLS level we were taught BGL yet the older EMTs on my squad years ago were not I take a BGL on all my patients yet the others just do the other vitals and skip the BGL.

As times change we adapt I guess.

Well, we have many items on our rigs that we do not use often- even in, or maybe BECAUSE of- a high volume system. I can think of many tools/meds/procedures we have use and carry, yet use only rarely, if at all. How many cricothyrotomies have folks done in their career? What about IO's? How many needle decompressions?

More studies need to be done(evidence based medicine) to further show the value of US as a diagnostic tool. Again- given the right circumstances, within the right system, I can see it as being valuable, and even potentially life saving. Problem is, with the economy such that it is, with budget cuts, and many services having trouble simply getting basic supplies and equipment for their rigs, ultrasound would be a a superfluous luxury. Additionally,- and probably key-is the system medical directors would need to buy into the idea, and would need to develop very specific protocols that would mandate it's use and integration into patient care. Think 12 lead EKG's here- unless the protocols are developed, and US becomes a standard of care for certain suspected complaints, even if a funding source was found(grant, donation from hospital or drug company, etc), the unit would be little more than a novelty item.

Again- I'm not questioning the potential of using US prehospitally, just the practicality and feasibility. Seems to be this would be a very location/system specific thing. Some systems would benefit immensely from it's use, while for many others, I think it would become a large, expensive paperweight.

[Peter Bonadonna]

Dear Healthcare Professionals,

I fear that you are prejudging a technology without fully understanding how it can be used. visit www.12leadekg.net/ultrasound for more info. I believe that 1 in 6 is accurate.

[tniuqs]

Interesting how treatment (and diagnosis) in Trauma evolves in war, but oddly EBM takes so long to hit the streets ?

I would like to suggest a book that was recently provided to me by rock_shoes.

http://www.amazon.ca/Fob-Doc-Ray-Wiss/dp/1553654722

The Book is called FOB DOC (Forward Operating Base Doctor) a Captain Wiess of Canadian Armed Forces Afghanistan (in passing all proceeds go to families of injured and KIA) the book outlines how successfully ultrasound can be used in trauma alone.

http://www.dmpibooks.com/book/fob-doc

The book explains just how valuable ultrasound can be for rapid dx and intervention in Mass casualties situations ie Pneumothorax Hemothorax or inter abdominal bleeding and central line insertion.

I want one !