The impact of prehospital use of ultrasound by EMS: Diagnostic and interventional benefits
Keywords:
prehospital ultrasound, trauma management, emergency medical services, systematic review, diagnostic accuracyAbstract
Background: Prehospital care, particularly for trauma patients, is complex due to the unpredictable environments in which emergency medical services (EMS) operate. The integration of prehospital ultrasound (PHUS) offers potential improvements in trauma management, a leading cause of mortality among younger populations in the U.S. Aim: This systematic review evaluates the application of PHUS in trauma management, focusing on its diagnostic and interventional benefits when utilized by different provider types, including EMS professionals, physicians, and mixed teams. Methods: A comprehensive literature search was conducted across multiple databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis used a PICO framework to compare ultrasound-assisted care with standard practices. A total of 16 studies were included for evaluation, assessing various ultrasound protocols and their impact on treatment decisions and outcomes. Results: The review highlighted significant variability in sensitivity and diagnostic accuracy among studies using PHUS. While the majority of studies involved physician-operated ultrasounds, limited research focused specifically on EMS professionals. Notably, the findings indicated that PHUS positively influenced treatment and transport decisions, although no studies directly addressed its effect on mortality rates.
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References
National Highway Traffic Safety Administration. (n.d.). National EMS scope of practice model. Retrieved March 13, 2020, from http://www.ems.gov/education/EMSScope.pdf
Al-Shaqsi, S. (2010). Models of international emergency medical service (EMS) systems. Oman Medical Journal, 25(4). https://doi.org/10.5001/omj.2010.92 DOI: https://doi.org/10.5001/omj.2010.92
National EMS Information System. (n.d.). V2 public EMS strong dashboard - NEMSIS. Retrieved March 13, 2020, from https://nemsis.org/view-reports/public-reports/version-2-public-dashboards/v2-ems-strong-dashboard/
Centers for Disease Control and Prevention. (n.d.). Products - Data briefs - Homepage. Retrieved March 30, 2020, from https://www.cdc.gov/nchs/products/databriefs.htm
Ultrasound guidelines: Emergency, point-of-care, and clinical ultrasound guidelines in medicine. (2017). Annals of Emergency Medicine, 69. https://doi.org/10.1016/j.annemergmed.2016.08.457 DOI: https://doi.org/10.1016/j.annemergmed.2016.08.457
Bahner, D., Blaivas, M., Cohen, H. L., et al. (2008). AIUM practice guideline for the performance of the focused assessment with sonography for trauma (FAST) examination. Journal of Ultrasound in Medicine, 27(2), 313-318. https://doi.org/10.7863/jum.2008.27.2.313 DOI: https://doi.org/10.7863/jum.2008.27.2.313
Nelson, B. P., & Sanghvi, A. (2016). Out-of-hospital point of care ultrasound: Current use models and future directions. European Journal of Trauma and Emergency Surgery, 42(2), 139-150. https://doi.org/10.1007/s00068-015-0494-z DOI: https://doi.org/10.1007/s00068-015-0494-z
Ketelaars, R., Reijnders, G., van Geffen, G. J., Scheffer, G. J., & Hoogerwerf, N. (2018). ABCDE of prehospital ultrasonography: A narrative review. Critical Ultrasound Journal, 10(1), 17. https://doi.org/10.1186/s13089-018-0099-y DOI: https://doi.org/10.1186/s13089-018-0099-y
Bøtker, M. T., Jacobsen, L., Rudolph, S. S., & Knudsen, L. (2018). The role of point of care ultrasound in prehospital critical care: A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 51. https://doi.org/10.1186/s13049-018-0518-x DOI: https://doi.org/10.1186/s13049-018-0518-x
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ, 339, b2535. https://doi.org/10.1136/bmj.b2535 DOI: https://doi.org/10.1136/bmj.b2535
Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2019). Cochrane handbook for systematic reviews of interventions version 6.0. Retrieved March 13, 2020, from www.training.cochrane.org/handbook DOI: https://doi.org/10.1002/9781119536604
Scottish Intercollegiate Guidelines Network. (2013). SIGN 50: A guideline developer’s handbook. Scotland: Health Care Improvement.
O’Dochartaigh, D., & Douma, M. (2015). Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review. Injury, 46(11), 2093-2102. https://doi.org/10.1016/j.injury.2015.07.007 DOI: https://doi.org/10.1016/j.injury.2015.07.007
Brun, P.-M., Bessereau, J., Chenaitia, H., Pradel, A.-L., Deniel, C., Garbaye, G., et al. (2014). Stay and play eFAST or scoop and run eFAST? That is the question! American Journal of Emergency Medicine, 32(2), 166-170. https://doi.org/10.1016/j.ajem.2013.11.008 DOI: https://doi.org/10.1016/j.ajem.2013.11.008
Busch, M. (2006). Portable ultrasound in pre-hospital emergencies: A feasibility study. Acta Anaesthesiologica Scandinavica, 50(6), 754-758. https://doi.org/10.1111/j.1399-6576.2006.01030.x DOI: https://doi.org/10.1111/j.1399-6576.2006.01030.x
Heegaard, W., Hildebrandt, D., Spear, D., Chason, K., Nelson, B., & Ho, J. (2010). Prehospital ultrasound by paramedics: Results of a field trial. Academic Emergency Medicine, 17(6), 624-630. https://doi.org/10.1111/j.1553-2712.2010.00755.x DOI: https://doi.org/10.1111/j.1553-2712.2010.00755.x
Hoyer, H. X., Vogl, S., Schiemann, U., Haug, A., Stolpe, E., & Michalski, T. (2010). Prehospital ultrasound in emergency medicine: Incidence, feasibility, indications, and diagnoses. European Journal of Emergency Medicine, 17(5), 254-259. https://doi.org/10.1097/MEJ.0b013e328336ae9e DOI: https://doi.org/10.1097/MEJ.0b013e328336ae9e
Ketelaars, R., Beekers, C., van Geffen, G. J., Scheffer, G. J., & Hoogerwerf, N. (2018). Prehospital echocardiography during resuscitation impacts treatment in a physician-staffed helicopter emergency medical service: An observational study. Prehospital Emergency Care, 22(4), 406-413. https://doi.org/10.1080/10903127.2017.1416208 DOI: https://doi.org/10.1080/10903127.2017.1416208
McNeil, C. R., McManus, J., & Mehta, S. (2009). The accuracy of portable ultrasonography to diagnose fractures in an austere environment. Prehospital Emergency Care, 13(1), 50-52. https://doi.org/10.1080/10903120802474513 DOI: https://doi.org/10.1080/10903120802474513
Prager, R., Sedgwick, C., Lund, A., Kim, D., Ho, B., Stachura, M., et al. (2018). Prospective evaluation of point-of-care ultrasound at a remote, multi-day music festival. Prehospital and Disaster Medicine, 33(5), 484-489. https://doi.org/10.1017/S1049023X18000821 DOI: https://doi.org/10.1017/S1049023X18000821
Press, G. M., Miller, S. K., Hassan, I. A., Alade, K. H., Camp, E., Del Junco, D., et al. (2014). Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. Journal of Emergency Medicine, 47(6), 638-645. https://doi.org/10.1016/j.jemermed.2014.07.056 DOI: https://doi.org/10.1016/j.jemermed.2014.07.056
Quick, J. A., Uhlich, R. M., Ahmad, S., Barnes, S. L., & Coughenour, J. P. (2016). In-flight ultrasound identification of pneumothorax. Emergency Radiology, 23(1), 3-7. https://doi.org/10.1007/s10140-015-1348-z DOI: https://doi.org/10.1007/s10140-015-1348-z
Scharonow, M., & Weilbach, C. (2018). Prehospital point-of-care emergency ultrasound: A cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 49. https://doi.org/10.1186/s13049-018-0519-9 DOI: https://doi.org/10.1186/s13049-018-0519-9
Walcher, F., Weinlich, M., Conrad, G., Schweigkofler, U., Breitkreutz, R., Kirschning, T., et al. (2006). Prehospital ultrasound imaging improves management of abdominal trauma. British Journal of Surgery, 93(2), 238-242. https://doi.org/10.1002/bjs.5213 DOI: https://doi.org/10.1002/bjs.5213
Yates, J. G., & Baylous, D. (2017). Aeromedical ultrasound: The evaluation of point-of-care ultrasound during helicopter transport. Air Medical Journal, 36(3), 110-115. https://doi.org/10.1016/j.amj.2017.02.001 DOI: https://doi.org/10.1016/j.amj.2017.02.001
Ketelaars, R., Holtslag, J. J. M., & Hoogerwerf, N. (2019). Abdominal prehospital ultrasound impacts treatment decisions in a Dutch helicopter emergency medical service. European Journal of Emergency Medicine, 26(4), 277-282. https://doi.org/10.1097/MEJ.0000000000000540 DOI: https://doi.org/10.1097/MEJ.0000000000000540
Ketelaars, R., Hoogerwerf, N., & Scheffer, G. J. (2013). Prehospital chest ultrasound by a Dutch helicopter emergency medical service. Journal of Emergency Medicine, 44(4), 811-817. https://doi.org/10.1016/j.jemermed.2012.10.008 DOI: https://doi.org/10.1016/j.jemermed.2012.07.085
Heegaard, W. G., & Sweeney, T. (2010). Prehospital ultrasound by paramedics: The future of emergency medicine. Air Medical Journal, 29(1), 1-3. https://doi.org/10.1016/j.amj.2009.08.004 DOI: https://doi.org/10.1016/j.amj.2009.08.004
Ketelaars, R., Horrevoets, L. J., & Hoogerwerf, N. (2015). The effectiveness of prehospital ultrasound: A meta-analysis. Prehospital Emergency Care, 19(2), 275-280. https://doi.org/10.3109/10903127.2014.958091
Hoyer, H. X., Ehlers, L. H., & Stolpe, E. (2018). Portable ultrasound in prehospital emergency medicine: Is there a place for training? European Journal of Trauma and Emergency Surgery, 44(2), 205-213. https://doi.org/10.1007/s00068-017-0783-6
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