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decision-making
clinical skills
assessment
devices
prehospital

Point-of-care ultrasound use in the pre-hospital setting

02 August 2018
Features
02 August 2018
Volume 10 · Issue 8

Abstract

In the pre-hospital setting, point-of-care ultrasound (POCUS) is a useful diagnostic tool that can provide additional clinical information to assist with pre-hospital management strategies and choice of hospital destination. Studies describing the clinical utility of paramedic-performed POCUS in the pre-hospital setting are lacking; however with the right training and education, paramedics are able to adequately obtain high-quality ultrasound images. Despite this, education programmes vary widely and a standardised approach is yet to be defined. The technology of ultrasound devices continues to evolve and in future, the transmission of ultrasound images to the receiving hospital should be a minimum requirement. While some studies report that POCUS influences pre-hospital management, data are lacking as to whether this improves patient outcomes. The authors have demonstrated the potentially significant role of POCUS in pre-hospital care; however this assessment modality does not replace physical examination, clinical experience and clinical decision-making.

Point-of-care-ultrasound (POCUS) is a useful diagnostic tool that has been used in hospitals to assist with decision-making in patients with critical illness. Owing to recent advances in technology and the ever-changing nature of paramedic work, POCUS has been introduced to the pre-hospital setting in a number of services (Nelson and Chason, 2008; El Sayed and Zaghrini, 2013).

In this environment, clinical assessment has relied on physical examination and history-taking. Diagnosis based on these factors alone may be insufficient, leading to under-recognition and therefore inappropriate triage of some clinical conditions (Meadley et al, 2017). This may have important implications for the patient and the healthcare system as a whole.

In the pre-hospital setting, POCUS can be used to assist in the diagnosis of many life-threatening conditions including hemoperitoneum, tension pneumothorax, myocardial dysfunction, volume status and pericardial effusion among others (Nelson and Chason, 2008; El Sayed and Zaghrini, 2013). Rapid identification of such conditions may assist with field triage, pre-hospital management strategies, early hospital notification, and hospital destination selection (Jaffer et al, 2011).

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Pre-hospital
Paramedic
Ultrasound
Emergency medical services
Trauma