Paramedics get ultrasound

usafmedic45

Forum Deputy Chief
3,796
5
0
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.
 

Melclin

Forum Deputy Chief
1,796
4
0
Yeah that all makes good sense in light of your PM messages re the echos from a little while ago.

Cheers usafmedic.
 

Scout

Para-Noid
576
2
18
Would ye shut the hell up about the flipping private vs fire.


Your runing the flipping thread.
 

usafmedic45

Forum Deputy Chief
3,796
5
0
Would ye shut the hell up about the flipping private vs fire.


Your runing the flipping thread.
Exactly. The summary executions should begin immediately.
 

usafmedic45

Forum Deputy Chief
3,796
5
0
Ignore him. He has hose envy.
How about we all just drop that insipid debate? I've worked both sides as both an EMT and a firefighter and both have their flaws (and plenty of them). It's not a matter of "hose envy". It's just a matter of people on both sides of the argument needing to stop being so immature and develop thicker skin. Just my two cents as a former fire department officer....
 
Last edited by a moderator:

WTEngel

M.Sc., OMS-I
Premium Member
680
10
18
Aside from trauma, I know prehospital ultrasounds can be used to assist placement of IV catheters and central lines.
 

sdadam

DialedMedics.com
124
4
18
I'm glad someone brought that up!

I got extensive training on the US in my ED clinical rotation in medic school, and looking for free air and blood was fun and all, but even with negative US findings, if the VS were out of whack (the article stated something about elevated heart rate) in the event of blunt trauma with a positive abdomen the PT is going to get an exploratory laparotomy unless the vitals can be explained in short order.

What was awesome was US guided vascular access! That crackhead that hasn't had a vein that could take an IV in a decade, no sweat with US. The diabetic that has two bad A/V grafts, and NO perif. veins left, no problem. It is awesome!

especially for those EJs on PT in cardiovascular collapse who weigh a ton and you can't see ANYTHING on the neck.

Now at 18,000 dollars a unit that probably doesn't justify getting one, but I would be all about it.

Adam
 

fortsmithman

Forum Deputy Chief
1,335
5
38
You made a blanket statement, and got called out on it. Your wording didn't leave any wiggle room for interpretation, it was quite straightforward.

I understood that linuss was referring to Texas agencies. You would have too if you saw the location where linuss is because the only Fort Worth I've heard of is in Texas.
 

Melclin

Forum Deputy Chief
1,796
4
0
Aside from trauma, I know prehospital ultrasounds can be used to assist placement of IV catheters and central lines.

An increasing difficult task according to a study done at Melbourne's Austin hospital ED. They apparently made a recommendations that more US machines be available to facilitate IV placement in bariatric patients. Interesting issue.
 

kmaultrasound

Forum Ride Along
4
0
0
Paramedics and Ultrasound-We would appreciate your input, please

This is not a commercial message; I have a deep personal interest in the best use of ultrasound in the hands of the paramedic.

Many years ago our private institute began fast track hands-on training courses in diagnostic ultrasound in all applications; we still do. As the Program Director, I want to get the best input from the front line as to whether and what training information/skills would be appropriate for the field.

In the very beginning of a long career in the field I had the great privilege to join the ranks of the very first EMT's in the country and I have always had a desire to contribute to the field. EMS needs all the tools and techniques on the scene, at the moment.

If you can help us focus our thoughts and resources toward this end we would all be most grateful.

Keith Mauney
 

eveningsky339

Forum Lieutenant
123
0
0
I honestly can't picture widespread application of a US aboard an ambo. How is it going to aide the ED? The patient?

I will wait for studies to make any conclusions.
 

Melclin

Forum Deputy Chief
1,796
4
0
But until EMS establishes some consistency in just their basic eduational foundation, the US has the same potential to be misused and misunderstood as the Pulse Oximetry and ETCO2.

Even here, where we have a good education, pulse oximetry is remarkably poorly understood. I'm told some of the rural guys acquired extension cables for the monitors so they could sit in the front during long transports with the pulse ox, secure in the notion that if the pt deteriorated in in way they would know through a lower pulse ox reading....Le Sigh.
 

kmaultrasound

Forum Ride Along
4
0
0
Prospective study on EMS ultrasound

Thanks for the input so far... It's really very instructive.

Earlier this year a study was launched in London to determine the efficacy of (and I trust the challenges with) ultrasound with EMS in the field. It's the only large scale trial I know of so far.
 

JPINFV

Gadfly
12,681
197
63
Thanks for the input so far... It's really very instructive.

Earlier this year a study was launched in London to determine the efficacy of (and I trust the challenges with) ultrasound with EMS in the field. It's the only large scale trial I know of so far.

Thanks. The one thing that concerns me about prehospital ultrasound is the usefulness. As I stated earlier, in my mind, the slice of patients in my mind who would truly benefit from this is rather small since the one's who are most likely to have a positive FAST exam would already be headed to a trauma center regardless of the results of an ultrasound exam.
 

VentMedic

Forum Chief
5,923
1
0
The other thing is do you rule in or rule out? Some bleeds are slower than others and may not be all that obvious especially if EMS response time is quick. However that doesn't mean there is not a bleed but if the Paramedic doesn't immediately see something and the patient ends up at a small hospital that takes 6 to 10 hours to get a facility transfer, that patient is essentially dead. Is the Paramedic going to go against the established trauma activation protocols? And, with established trauma activation protocols, wouldn't you be going to the trauma center? The trauma center will have surgical services. If you are in the middle of nowhere, will you have the confidence of all surgeons who might get called in? How did it work before? Did your ED doctors not trust your field assessment for certain situations?

The US is great to confirm who you might already suspect but even if air or blood is not immediately visible by US, that doesn't mean it is not happening. There are reasons why several tests are done in a hospital before a surgeon will even consider cutting.

For the FD in Florida that now has the US, they will be seriously explaining themselves if they violate the state's trauma protocols and divert to a local little general hospital because they didn't think they saw anything.

Also, not all bodies will be a slim 70 kg young male. Nor will they all be in the perfect body position or even have perfect anatomy.
 
Top