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Emergency ultrasound in the prehospital setting

04 February 2011
Features
02 February 2011
Volume 3 · Issue 2

Abstract

Paramedic practice in the UK has seen some diverse and lengthy changes in the last ten years. The way that ambulance services are now involved in emergency care is very different, with more focus placed on the efficient and appropriate use of other primary and secondary care resources. The advent of closer and more formal working relationships between prehospital care physicians and paramedics will provide the opportunity to further develop the quality of care delivered by the doctor-paramedic team. It is now widely accepted that for the most seriously injured patients out of hospital, the application of physician-led skills such as prehospital anaesthesia contribute significantly to the process of the early management of trauma and improvement of outcome (Van der Hoeven and De Koning, 1995). Similarly, the development of the team approach has meant that more goal–led therapies can be instituted in a timely fashion. The use of ultrasound in the prehospital environment is not new. While its role is not yet fully established (Brooke et al. 2010), it is nevertheless finding its rightful place in the hands of both trained physicians and paramedics. The diversity of applications for paramedic–led ultrasound is also gaining momentum with high levels of sensitivity and specificity reported (Heiner and McArthur, 2010; Tazarourte et al, 2010). This article addresses some of the issues regarding the use of ultrasound in prehospital care and describes some of the applications which are taught in the emergency and prehospital ultrasound course at the Imperial College, London.

There is now much emphasis placed on dynamic and appropriate triage, with evidence clearly suggesting better outcomes when certain injuries are triaged directly to specialist centres (Sampalis et al, 1997; Sampalis et al. 1999). The ability to enhance decision-making skills at the scene will therefore be a welcome addition to the skills base of prehospital care practitioners. The use of a focused scanning approach means that training and initial competence are easy to accomplish and within a framework of audit and governance are easy to review and monitor.

In addition, prehospital ultrasound can guide the practitioner to make better, more informed decisions as to the feasibility and merits of further on–scene care. This means that findings of on– scene ultrasound can be used in an algorithmic approach as to the functional endpoint of on-scene care—thus avoiding unnecessary delay in reaching definitive care.

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Education
Emergency ultrasound
FAST
Training