X-rays in Ambulances

[Ace844]

Acknowledging all of the afformentioned problems related to this concept, I do have to admit that I see some potential benefits to this. While I suppose it is natural to think "ortho" when talking x-rays, we have to remember that there are many, many other diagnostic values to radiology. Here are some examples of a few non-orthopedic conditions a field x-ray could tell me of that my patient would benefit from me knowing:

The gold standard for ET tube placement is direct visulaiziation of it passing thru the "cords" If this occurred, you have no need to see an "X-Ray" to "prove the tube is in, furthermore, if all of the the other "assessment markers" of ET entubation are correct i.e.:ETCO[s:31ca9c824b]2[/s:31ca9c824b], Breath sounds, etc... then the there is no value or change in your management...Matter of fact it is most often done as a "documentation/litigous defense" in-hospital...

[Dustdevil]

hmmm..again I submit for consideration that management for these are clinically and assessment based...baring the ability for you to do pre-hospital chest tubes of course...then I may agree with this point!

As noted in the last statement of my post, the value of any and all of these will be dependent upon the sophistication of the EMS system and the remoteness of the incident. Since most of the United States -- indeed most of the world -- is not in immediate proximity to a trauma center like you are, then at least the distance caveat applies to most systems. And although probably a great minority of them are clinically sophisticated to be doing thoracostomies in the field, they should be. And I would expect it to become more common in the future. Of course, field radiology would create a confidence necessary for many systems to consider thoracostomies.

[Ridryder 911]

I agree with most of the post however, simple chest decompression over 7-10 minutes usually is occluded & re-needle decompression is needed again. No, not all medics need need to perform this procedure as well. I hope no physician waits for a X-ray to perform a decompression or chest tube placement.. and yes, it is recommended not to wait for X-ray to confirm a pnuemo or hemo..

Be safe,

R/R 911

[fire48emt22]

I have been doing some research for a school report on the Future of EMS, so far i have come up w/ the fact that some places are treating the pts on scene and releasing them, ie, cuts that need sutures are now done in the field, diabetic emergencies are being treated and released, seizure pts, the list goes on and on.

so heres my thought (its not worth anything but y not right), we are doing all this stuff already in the field so y not x-rays, we can help in some places (if the hospitals take the in field films, some hospitals here dont except in field blood draws so y waste the time and effort if it wont be used?) but on the other hand, i am still concerned about the training requirements, we have to learn how to use it, but do we have to learn how to read it as well? whats the point of learning to use the machine if we can read the x-rays? we can do some good w/ this but we can do some damage if given to the wrong emt or medic. and the fact that yes this piece of equipment may be "small" in size but its still another piece of equipment that we are going to have to carry around and check, and where are we going to put it, i don't know about where everyone else works but i do know that we are very pressed for space in our ambulances. And how are we going to be reimbursed for the films we take if the insurance companies won't approve it yet?

We have to look at the research and see if the outcome of the pt is worth the effort of training and time on our part. I say if it is not going to help at least 1 of my pts don't bother me about it.

Just a few mindless thoughts thats all.

[flight-lp]

As there is absolutely no relevence to treatment in the field and the fact that x-rays will delay care and cause further manipulation of the patient thus increasing pain, in field radiology is pointless IMHO. From a financial standpoint, as others have pointed out, the ones who could remotely have a general hypothesis for use are the ones who cannot afford it. Plus the "outlying" regions need to focus on what really needs to be accomplished; getting the patient to a definitive care facility, not playing radiologist. If distance is a factor, fly 'em. After all, thats why aeromedical evacuation was started in the first place..

[Dustdevil]

Except that half they time, they are unable to fly due to weather. So now I am stuck with a minimum one hour long drive to the nearest trauma center. If I can spend that hour doing something more productive than praying, then I will. And mobile radiology might offer that option.

[flight-lp]

Valid point and in that given circumstance where a helo isn't available whether it be for weather, PM, or the local helo being out on another mission, providing it doesn't affect other care, then yes I guess it wouldn't hurt. But again, its an item that regardless of its diagnostic capability, will not change treatment. If its broke, you splint it. If you do not have circulation, then you set it and splint it. The insurance companies are not going to reimburse for its use as they will never allow a paramedic to interpret (hell, they are in the near future going to restrict much of their reimbursements with flight charges being at the top of their list!) and again it is really a cost issue. In this case I would just haul ass to the closest most appropriate facility and focus on reassessment and hemodynamic maintenence. I agree with you though that it absolutely sucks not having air resources when they are needed. Believe me when I say it is extremely bothersome to the flight crew too. But flight minimums must be maintained as it is always better to have one critical trauma patient than a critical trauma patient who is now dead along with 3 others....................