Medics can do ultrasonography in a moving ambulance

[ExpatMedic0]

MINNEAPOLIS — Paramedics can obtain and interpret ultrasonograms in the back of moving ambulances, new research confirms. "Prehospital ultrasound has the potential to improve patient outcomes by improving time to diagnosis and early delivery of critically ill patients who are amenable to time-dependent lifesaving interventions," the researchers note. "It also has the promising ability to assist in making appropriate destination decisions for the patient."

Read more below

http://www.ems1.com/medical-clinical/articles/841725-US-Study-Medics-can-do-ultrasonography-in-a-moving-ambulance/

 

[Stephanie.]

MINNEAPOLIS — Paramedics can obtain and interpret ultrasonograms in the back of moving ambulances, new research confirms. "Prehospital ultrasound has the potential to improve patient outcomes by improving time to diagnosis and early delivery of critically ill patients who are amenable to time-dependent lifesaving interventions," the researchers note. "It also has the promising ability to assist in making appropriate destination decisions for the patient."

Read more below

http://www.ems1.com/medical-clinical/articles/841725-US-Study-Medics-can-do-ultrasonography-in-a-moving-ambulance/

We started using ultra sonograms in South Carolina, before I moved. We had training on them during in service and they were going to be placed in the rigs that were in a more rural area and had a long transport time.

It was interesting to use, even in training. But honestly I don't think they would be very effective in any moving vehicle because you have to be so precise.

 

[46Young]

I don't see it being practical in an urban environment with short txp times. On a good trauma, I'm doing a rapid trauma assessment as the pt is being secured to the LSB by others. When we get in the back, I'm grabbing one or two others, and I'm out. By the time we get a set of vitals, airway if necessary and O2 onboard, and call the hospital, we're basically pulling up to the ED. Any spare time is used to get a line or two, an ECG and BGL.

I'm all for expanding our scope, believe me, but our main function is txp to definitive care and stabilization while onscene and during txp. Anything that lengthens the pt contact to ED delivery time without providing any immediate benefit to the pt's hemodynamics seems like more of a gee whiz, gimmick type thing.

My question is, how long would it take to set up a field ultrasound, how reliable are the results, will the receiving ED accept the results, will it delay txp, and will it delay any higher priority interventions? Also, if it happens to be a quick procedure, I'm sure the trauma team can do it just as fast, in a more controlled environment.

 

[WTEngel]

I tend to agree that in general, the use for pre hospital ultrasound is limited. The last service i worked for was a specialty transport critical care flight service, and we used the ultrasounds for vascular access and for all of our trauma stat patients with abdominal injuries. With at being said, we would never delay transport in order to do an in depth ultrasound survey...but in less than 3 minutes you can do a general survey of the abdomen and give the accepting physician a good idea of if immediate surgical intervention is necessary. This means we could roll right by the ED and straight to surgery if need be. There was also a time or two where difficult vascular access was obtained by ultrasound visualization.

As with anything, it was a good tool to have, but of course ABCs always come first, and this is just icing on the cake...

 

[bstone]

I can definitely see the use in more rural areas with longer t/p times. I would be happy if the images could be immediately sent to the ER for interpretation and medical direction.

 

[Stephanie.]

I can definitely see the use in more rural areas with longer t/p times. I would be happy if the images could be immediately sent to the ER for interpretation and medical direction.

As I was saying, my old service began using this. We had a lot of complications with sending EKG's to the hospital- so our Medical Director looked into cell phones for the trucks with picture sending capability. So if we had an STEMI or any other EKG we felt would help speed up the ED process for that particular patient. We would take a picture and email it to the nurses at the charge station. We also began doing this with the ultra sonograms. Til this day I know it works well with the EKGs, but not many of the crews are interested in it.

 

[rhan101277]

I think this does much for the profession, helping medics to be noticed as clinicians and professionals.

Anything for some better patient outcomes.

 

[zmedic]

You'd need some data to show that it improves outcomes. Which I don't think have been done before.

The argument for trauma is that a positive FAST exam in an unstable patient pushes you to bypass CT and take the patient to the OR. So what's the utility of FAST in prehospital? You wouldn't not take a patient to a trauma center with a negative FAST. Unstable patient's aren't going to be bypassing the ED anytime soon to go to the OR just because they have a positive FAST. So I'm not really sure that a medic saying "I think I have a positive FAST on an unstable trauma patient" is going to get the ED to do much different than if they said they had an unstable patient with abdominal pain.

There is also the issue that a lot of data saying what saves lives is quick transport to hospital in trauma. Some of the data suggests that ALS leads to worse outcomes, possibly because ALS interventions such as intubating and IVs extending scene times. So there is a big concern that doing an ultrasound will delay scene time, or distract the medic from doing things that actually could help the patient right there, like pain control, monitoring breath sounds for pneumothorax, monitoring vital signs, splinting, getting demographic data for the patient.

It's just like intubation. Everyone thinks that they can intubate in 2 minutes because they are so good. But when you look at the data a lot of people take a lot longer than that. The average line medic is going to take awhile to do a full FAST exam, because they just aren't doing enough of them. The problem with a lot of these studies that go "hey, medics can do X procedure well" is that it often is done at an agressive service, with motivated medics who are looking to push the frontiers of medicine. They get a bunch of training, practice a lot because they know they are in a study. Which is great, but it raises questions about how well that data translates to the average provider who just gets some ultrasound training during medic school, works in a low volume area and does 2 or three ultrasounds a month.