Prehospital Assessment with Ultrasound in Emergencies - PAUSE II - Implementation in the Field

Background: Point-of-care ultrasound is an ideal imaging modality in the emergency department. Its study in the prehospital setting is limited. We previously published on paramedics' ability to perform basic scans and recognize pneumothorax, pericardial effusion and cardiac standstill under classroom conditions. In this study, we trained paramedics to use cardiac ultrasound in the field.Objectives: To determine whether paramedics are capable of obtaining cardiac ultrasound scans at a level adequate for decision-making. The primary outcome was a percentage of paramedic scans judged as adequate for clinical decision-making. Methods: This was a prospective educational intervention using a convenience sample of professional paramedics with no prior US experience. Paramedics participated in a 3-hour training session then used US during dispatch calls. They saved scans for complaints of: chest pain, dyspnea, loss of consciousness, trauma, cardiac arrest. The scans were later evaluated by two ultrasound-trained emergency physicians.Results: Overall, four paramedics obtained adequate scans 89% of the time. In total, 17/19 unique patient studies were adequate for clinical decision-making. Two studies were of inadequate diagnostic quality. Two cardiac arrest studies were logged and paramedics correctly identified these cases as cardiac standstill.Conclusion: Implementing ultrasound in the prehospital setting is challenging. Many unforeseen variables interfered with the study. We did not achieve statistical significance, so the study must be interpreted as a hypothesis-generating study. Areas to improve in future studies include continuity of enrollment and data collection. Focus should be on improving outcomes in survival, quality and resource allocation