Forum Deputy Chief
We also had the US on our helicopter a few years ago but it made little difference in the distination or treatment and at a Level 1 trauma center there will be a surgeons. The money for the equipment, maintenance and training was put to much better use.
Vent, why wasn't the HEMS ultrasound useful for the ED?
Is it possible for pre-hospital ultra-sound to be used in any way to triage straight to theatre in the same sense as pre-hospital twelve leads allow for triage direct to cath labs? Seems like there are things that the ED would want to do first (inbetween EMS and theatre) but does an EMS US cut anytime off the ED process? Any good papers on it?
Because it's not as easy to do the studies as people think it is. Especially in the back of a moving aircraft, let alone an ambulance bouncing down a dirt road. Trust me....I did both while in the Air Force; even with several hundred scans to my credit, the learning curve was steep and the diagnostic yield is really low in most cases because you often can't get the shots you need or they are equivocal. It's really a skill that has to almost be done either going through smooth air or sitting still on the ground. And that's assuming a healthy, skinny person (like a military member) versus a fat to morbidly obese trauma victim as is becoming increasingly common in civilian circles....
It's another one of those ideas that sounds good on paper but all it does is delay access to definitive care. Honestly 95% of your cases that are going to have frank findings on the US that would allow you to make a treatment/transport decisions (especially without a lot of experience under your belt) are going to present with other things (vital sign derangements, etc) that are going to allow you to make the call without the delay.
Is it enough information to go straight to theatre with? If ED's aren't doing that sort of thing is it because its not feasible clinically or is it because they don't trust EMS FASTs. Does it/could it actually cut any time of the accident to knife time?
Also a lot of hospitals are still going to re-scan the person in the ED anyhow just to make sure they aren't going to be operating on someone who doesn't need it. Especially in those cases where you "maybe" have free fluid in the abdomen or "maybe" have hemopericardium. As Vent said, the money is better spent elswhere because the diagnostic yield is very low especially in the hands of people who really don't have the experience and education to be making judgment calls off of scans.