M. Helm2, E. Villegas2, P. Mammen2, N. Ellis2, S. Joseph1 1Valley Health System,Las Vegas, NV, USA 2Texas Tech University Health Sciences,Department Of Surgery,Odessa, TX, USA
Introduction:
In rural settings, timely access to medical care is the main contributor to complications. In West Texas, the average time from injury to EMS arrival is approximately 80 min and arrival to the definitive site of care is over 167 min.
Early identification of injury reduces triage time, enhances appropriate utilization of resources, and improves outcomes. Point of Care Ultrasound (POCUS) is used to visualize major injuries and identify sources of shock. However, image acquisition and interpretation in the prehospital setting is difficult, requires extensive training, and may be time consuming. We set out to see if first responders could acquire adequate images with minimal training and quantify the added triage time needed for POCUS.
Methods:
EMS from rural counties were trained using a 2-hour hands-on course in the use of POCUS. Images included neck, pulmonary, cardiac, abdomen, and pelvic windows. Surveys of first responders were used to assess skill acquisition and usefulness of training sessions.
EMS were then given POCUS for a 3 month field test. Images were saved for evaluation. Surgeons reviewed images to assess image quality and identification of target structures.
After completion of the field test, first responders were surveyed to assess ease of use, technical complications, and total added time.
Results:
63 first responders were trained on POCUS. All trainees felt that POCUS would be beneficial in triage. 82.5% (52/63) trainees wished to have further training. 30% (19/63) had difficulty with the pulmonary images.
57 patients were recorded by the trained EMS, with 19 patients for trauma.
Cardiac and abdominal images were good quality and target structures were identified in 93% of all patients. 2 patients had images concerning for free intraperitoneal fluid. Tracheal imaging was done on only 6 patients.
39 EMS completed follow up surveys. All reported the POCUS was easy to use. The average time to complete POCUS was 3 minutes. Technical difficulties included the length of the probe cord, charging of the devise on an ambulance, and ambient lighting within the ambulance. Interest in expanded use included transfer of images, vascular access, imaging for other conditions, and interpretation of images while in transit.
Conclusion:
EMS can perform POCUS after a short hands-on session. Images obtained appear to be adequate to identify major injuries. Triage decisions and field resources can be maximized using POCUS. We believe the cost of adding POCUS to rural EMS is offset by improved triage time, reduction of wasted resources, and improved survival.
We note the expanded use of POCUS by EMS for patients with other conditions may further reduce the upfront cost of this program. Finally, we noted great interest from the rural hospital emergency room to have access and training to this tool.
We recommend Wifi capabilities to allow image interpretation while in transit and direct communication between EMS and trauma surgeons in rural areas.