Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review

Background: Trauma is a leading cause of death in the United States. Ultrasound use in the prehospital environment has the potential to change trauma management. Although ultrasound use for prehospital trauma is increasing, the role of this modality is not clearly defined. Objectives: The objectives of this article are to examine the use of prehospital ultrasound for trauma patients including its use by different provider levels. Specific outcomes of interest are if the use of prehospital ultrasound has been shown to improve providers’ ability to recognize conditions that can be managed in the prehospital setting, treat these conditions, change transport destination, or improve overall mortality rates for trauma patients. Methods: A search of multiple databases was conducted to systematically review the evidence-based literature addressing these specific outcomes. Abstracts and articles were examined and studies that did not specifically evaluate ultrasound in the prehospital setting for trauma and duplicates were eliminated. Studies that were identified and included in this comprehensive review were assessed for the use of ultrasound in the prehospital setting to aid in the diagnosis, treatment, and transport of trauma patients. An analysis of bias in the included articles was also conducted. Due to the large variability in the included studies, no meta-analysis could be performed. Results: Sixteen studies were included in this review with 3,317 total patients that underwent prehospital ultrasound examinations for trauma. Twelve of the 16 studies were prospective and observational, three were retrospective evaluations, and there was one randomized control comparison study. One study solely utilized Emergency Medical Services (EMS) professionals as the ultrasound operator. Ten of the 16 studies involved physicians in a helicopter Emergency Medical Service (HEMS) setting. Five studies involved mixed systems of care that included physicians, nurses, and EMS professionals. Ten of the 16 studies involved physicians in a helicopter Emergency Medical Service (HEMS) setting. The included studies varied widely regarding methodology, ultrasound protocols, and outcome measurements. Conclusion: Ultrasound use in the prehospital setting for trauma appears feasible and demonstrates potential. However, the evidence in the medical literature mainly consists of prospective observational studies of physicians utilizing ultrasound for trauma in a HEMS setting. Further scientific research must be undertaken to firmly establish the role of prehospital ultrasound in trauma management by all levels of EMS providers