Peer ReviewedUltrasound for the air medical clinician☆
Introduction
Recent advances in technology have made the use of ultrasound (US) a possibility in air medicine. A handheld US machine that appears promising as a diagnostic tool within the helicopter theater was developed recently (Sonosite Corp., Bothell, Wash.). Several air medical programs have begun using US as the focused abdominal sonography for trauma (FAST) examination during helicopter transport.1, 2
Diagnostic US greatly enhances the evaluation of patients with a variety of presentations. After its rapid evolution during the previous decade and wide availability in operating suites and emergency departments, US technology now is being introduced into the out-of-hospital arena. Many patients who present with unstable or time-critical medical problems require on-the-spot diagnosis and intervention. These patients may benefit from rapid, goal-directed, limited ultrasonography performed and interpreted by flight clinicians.
We integrated the use of a Sonosite 180 US device in our flight program at Life Link III in April 2001. This article describes our training program for flight clinicians, proposes a platform for subsequent program development, and shares the results of our experience in air medicine.
Section snippets
Methods
Our objectives were to develop a US training program for air medical clinicians using focused US examinations and assess the competencies of each clinician 1 year later. We conducted a prospective observational study on critical patients transported by Life Link III between July 1, 2001, and July 1, 2002.
Life Link III (LLIII) is a full-service transport program that provides both ground and air critical care services to a tri-state region. LLIII provides more than 6000 ground transports and
Ultrasound training
The training program was developed by one of the authors (Plummer) with a focus on a narrow US examination with specific indications, such as hypotension, change in vital signs, high clinical suspicion, etc. The course consisted of 7 hours of didactic and hands-on training designed for a dedicated crew of 10 flight nurses and paramedics. All flight nurses and paramedics had more than 5 years of clinical experience. The course began with a general introduction to US, US physics, and the use of
Results
Table 2 compares the scores on the written tests administered in July 2001 and July 2002. Table 3 summarizes the results of the practical tests.
One hundred air medical patients had a US performed during convenient sampling from July 1, 2001, to July 1, 2002, with 39 classified as medical cases, 52 trauma, 8 obstetric, and 1 neonate. Regarding both medical and trauma cardiac patients, 99% (85/86) of US scans were read as negative by the air medical crew and physician who overread US images (MD)
Discussion
Ultrasound in emergency medicine has greatly improved patient care since the first published report by emergency physicians in 1979 by Mayron.6 With the recent improvements in small handheld devices, its use within the prehospital environment is inevitable. Price et al1 have shown that US can easily be performed in the helicopter without equipment failure. Work by Melanson et al2 using handheld US devices showed that they do vary significantly and that performing a FAST examination may not
Limitations
This study had several limitations. First, this is an observational study in which patients were not selected randomly and thus has all the biases and limitations that apply to nonrandomized studies. Second, the study had 1 reviewer of all the US images. We hope to follow this study with a project in which multiple US-trained emergency physicians read images blindly. Last, the total number of US images included in this study is small. A larger study with more positive findings (ie, pericardial
Conclusion
US in the air medical setting is feasible using air medical crews with a relatively high level of retention, skill, and knowledge over a 1-year period. Our template provides a reasonable training platform for advancing US in the air medical setting. Specificity was high in this small study. Further study will be needed to determine the exact indication and role of US in the prehospital setting.
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Cited by (0)
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Presented at Airmed 2002, Interlaken, Switzerland, September 2002, and the Society of Academic Emergency Medicine, Boston, MA, May 2003.