Who Uses Ultrasound in EMS Worldwide ?

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Permalink Reply by Brian Dunnigan on November 22, 2009 at 8:14pm

http://www.911sono.com/new_clips.htm

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Permalink Reply by Brian Dunnigan on November 22, 2009 at 8:16pm

http://www.winfocus.org/

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Permalink Reply by Brian Dunnigan on November 22, 2009 at 8:16pm

I posted some links that some of you may find interesting.

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Permalink Reply by Jonathan Gilliam on November 22, 2009 at 10:40pm

I was reading a article on this just last night. Honestly, I don't see where there can be a benefit. If there's been a study on it's advantages, I'd like to see them. Otherwise, I think putting these on an ambulance is just a waste of money and resources. There is nothing that we can gain from this device pre-hospital that we can find with a full exam, and form a clinically based working diagnosis. Not only that, I would hypothesize that it would add to scene times in patients who need shorter scene times. So we're not using it, and we don't have any plans to add it to our scope of practice. Maybe, if in the future, studies prove this to be of benefit, and that it decreases patient mortality, then we might look at adding this. I'll be keeping my ears open on this one.

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Permalink Reply by Brian Dunnigan on November 23, 2009 at 10:09am

Let me see if I can state some of the benefits so you may have a better understanding of what ultrasound does do.
We can see pnuemo's very clearly and very quickly.You can state that PE reveals this but you can't say that it is a true condition based on decrease breath sound.
We can see a triple AAA decide on treatment, ( is it clotted of or not) is the patient stable in a hypovolemic state.
We can see free fluid in the abdomen. Notify hospital to set up for surgical case and decrease door to surgery times which is a significant benefit.
You can look at the IVC (inferior vena cava and tell if you need fluid rescusitation right away or vasopressors.This appears very helpful.
If you see a tamponade you can speed up the pump with fluid and potentially give your patient more time to get to the hospital based on recognition and TREATMENT.
Great use in HEMS since noise can be a factor in assesing lung sounds and heart sounds.
You can see commet lines in the lungs to differentiate COPS and CHF. Not all CHF is overload problem as it is fluid shift.
We can see hypokenesis of the heart wall which can be a gold sign for cathlab.
Most agencies that have implemeted ultrasound are not delaying transport to perform the skill.However if you see no benefit in it for your agency then thats your descision.
Cost IMO should not outway better patient care and better stratification of patients to where they should go.
I will post more data so you can see the results.
When you say your there is nothing to gain by using them , your making a blanket statement about its use without due dilligence.
If its cost vs. better patient care get over it..............LOL not personal

Jonathan Gilliam said:

I was reading a article on this just last night. Honestly, I don't see where there can be a benefit. If there's been a study on it's advantages, I'd like to see them. Otherwise, I think putting these on an ambulance is just a waste of money and resources. There is nothing that we can gain from this device pre-hospital that we can find with a full exam, and form a clinically based working diagnosis. Not only that, I would hypothesize that it would add to scene times in patients who need shorter scene times. So we're not using it, and we don't have any plans to add it to our scope of practice. Maybe, if in the future, studies prove this to be of benefit, and that it decreases patient mortality, then we might look at adding this. I'll be keeping my ears open on this one.

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Permalink Reply by Brian Dunnigan on November 23, 2009 at 10:54am

http://www.resuscitationjournal.com/article/S0300-9572(07)00367-X/abstract

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Permalink Reply by Brian Dunnigan on November 23, 2009 at 10:58am

http://www.resuscitationjournal.com/article/S0300-9572(03)00245-4/abstract

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Permalink Reply by Brian Dunnigan on November 23, 2009 at 11:03am

http://www.trauma.org/index.php/community/list/url/http:list.ftech....

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Permalink Reply by Brian Dunnigan on November 23, 2009 at 11:19am

http://www.ingentaconnect.com/content/jws/bjs/2006/00000093/0000000...


It does change how you can treat your patient. I will post more USA studies as I group them. Hope this helped and feel free to ask any questions.

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Permalink Reply by Anthony Gorman on November 23, 2009 at 11:28am

Mount Sinai in NYC ran a pilot for a while on pre hospital ultrasound. It was called PFAST. Prehospital Focused Assessment with Sonography in Trauma : A study of the feasibility of ultrasound in trauma, performed by PARAMEDICS in the field

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Permalink Reply by Brian Dunnigan on November 23, 2009 at 11:40am

http://emedicine.medscape.com/article/827551-treatment

Yes I know. Thank you Anthony for adding that to the forum. Data is still so new that its very slow to come forward.
The theroy that more studies need to be done is old news for me. I remember 12 lead ECG's were not on the top of the hit parade for us in EMS and now they are a standard of good care.
Evidence based medicine is great but we do need to start somewhere ! If we decide not to do it we can't get further data.
Bret Nelson MD was the medical director of that study. William Heegard MD in Hennapin County like his results. Nobody will ever take away David Spears MD ultrasound program at Odessa Teaxas Fire Dept.
Star Flight Austin Tezas uses it and other ground and HEMS services.
They must feel that there is some benefit and its not just another tool for useless data.

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Permalink Reply by Neil White on November 23, 2009 at 2:25pm

I get the feeling that in order to get a clear picture you're going to need to be very precise in what you are doing. I would be interested to know what an accurate timing would be to perform this procedure (by a practitioner that would perform it as rarely as a paramedic). if your +5 minutes or greater than your transport time to ER i would question its validity.

I look at the use in AAA and wonder whether it effects our treatment plans in the field. A patient with a suspected AAA is going to still be a surgical emergency and a pre-alert is still going to be made whether you know the detailed specifics or not.

I would also question the reliability of performing the ultrasound on route... one bump and you've got a misdiagnosis and if we're talking about the critical trauma or medical patients isn't there other things we need to be doing?

I'm a firm believer in keeping it simple, so if it is implemented surely medics aren't able to wave it around without any formal training. The risk of misinterpreting radiological studies is well reported. The senior doctors in our emergency department are forever recalling patients where fractures ect have been missed or whatever from junior doctors and nurse practitioners.

One would also consider the need for telemetry or a way to share the results with ER doctors without it the ultrasound would be re-preformed in order to confirm the working diagnosis. I feel a lot more work to do before it is considered along side the 12 lead ecg.

Brian Dunnigan said:

Let me see if I can state some of the benefits so you may have a better understanding of what ultrasound does do.
We can see pnuemo's very clearly and very quickly.You can state that PE reveals this but you can't say that it is a true condition based on decrease breath sound.
We can see a triple AAA decide on treatment, ( is it clotted of or not) is the patient stable in a hypovolemic state.
We can see free fluid in the abdomen. Notify hospital to set up for surgical case and decrease door to surgery times which is a significant benefit.
You can look at the IVC (inferior vena cava and tell if you need fluid rescusitation right away or vasopressors.This appears very helpful.
If you see a tamponade you can speed up the pump with fluid and potentially give your patient more time to get to the hospital based on recognition and TREATMENT.
Great use in HEMS since noise can be a factor in assesing lung sounds and heart sounds.
You can see commet lines in the lungs to differentiate COPS and CHF. Not all CHF is overload problem as it is fluid shift.
We can see hypokenesis of the heart wall which can be a gold sign for cathlab.
Most agencies that have implemeted ultrasound are not delaying transport to perform the skill.However if you see no benefit in it for your agency then thats your descision.
Cost IMO should not outway better patient care and better stratification of patients to where they should go.
I will post more data so you can see the results.
When you say your there is nothing to gain by using them , your making a blanket statement about its use without due dilligence.
If its cost vs. better patient care get over it..............LOL not personal

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