Prehospital Ultrasound by Paramedics: Results of Field Trial

Authors

  • William Heegaard MD, MPH,

    1. From the Department of Emergency Medicine, Hennepin County Medical Center (WH, DH, JH), Minneapolis, MN; the Department of Emergency Medicine, Parkland Hospital (DS), Dallas, TX; and the Department of Emergency Medicine, Mount Sinai School of Medicine (KC, BN), New York, NY.
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  • David Hildebrandt NREMT-P, RN,

    1. From the Department of Emergency Medicine, Hennepin County Medical Center (WH, DH, JH), Minneapolis, MN; the Department of Emergency Medicine, Parkland Hospital (DS), Dallas, TX; and the Department of Emergency Medicine, Mount Sinai School of Medicine (KC, BN), New York, NY.
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  • David Spear MD,

    1. From the Department of Emergency Medicine, Hennepin County Medical Center (WH, DH, JH), Minneapolis, MN; the Department of Emergency Medicine, Parkland Hospital (DS), Dallas, TX; and the Department of Emergency Medicine, Mount Sinai School of Medicine (KC, BN), New York, NY.
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  • Kevin Chason DO,

    1. From the Department of Emergency Medicine, Hennepin County Medical Center (WH, DH, JH), Minneapolis, MN; the Department of Emergency Medicine, Parkland Hospital (DS), Dallas, TX; and the Department of Emergency Medicine, Mount Sinai School of Medicine (KC, BN), New York, NY.
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  • Bret Nelson MD, RDMS,

    1. From the Department of Emergency Medicine, Hennepin County Medical Center (WH, DH, JH), Minneapolis, MN; the Department of Emergency Medicine, Parkland Hospital (DS), Dallas, TX; and the Department of Emergency Medicine, Mount Sinai School of Medicine (KC, BN), New York, NY.
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  • Jeffrey Ho MD

    1. From the Department of Emergency Medicine, Hennepin County Medical Center (WH, DH, JH), Minneapolis, MN; the Department of Emergency Medicine, Parkland Hospital (DS), Dallas, TX; and the Department of Emergency Medicine, Mount Sinai School of Medicine (KC, BN), New York, NY.
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  • Preliminary data from this study were presented at the 2009 National Association of EMS Physicians annual meeting in Jacksonville, FL; and the 2009 World Interactive Network Focused on Critical Ultrasound meeting in Sydney, Australia.

  • SonoSite Corporation provided all MicroMaxx ultrasound machines free of charge. SonoSite Corporation provided an unrestricted grant for this study. Other sources of financial support came from the Hennepin County Medical Center Department of Emergency Medicine, the Hennepin County Medical Center Emergency Medical Services, and the Edina Fire Department, Edina, MN.

Address for correspondence and reprints: William Heegaard, MD, MPH; e-mail: william.heegaard@hcmed.org.

Abstract

Objectives:  The objective was to determine if 9-1-1 paramedics trained in ultrasound (US) could adequately perform and interpret the Focused Assessment Sonography in Trauma (FAST) and the abdominal aortic (AA) exams in the prehospital care environment.

Methods:  Paramedics at two emergency medical services (EMS) agencies received a 6-hour training program in US with ongoing refresher education. Paramedics collected US in the field using a prospective convenience methodology. All US were performed in the ambulance without scene delay. US exams were reviewed in a blinded fashion by an emergency sonographer physician overreader (PO).

Results:  A total of 104 patients had an US performed between January 1, 2008, and January 1, 2009. Twenty AA exams were performed and all were interpreted as negative by the paramedics and the PO. Paramedics were unable to obtain adequate images in 7.7% (8/104) of the patients. Eighty-four patients had the FAST exam performed. Six exams (6/84, 7.1%) were read as positive for free intraperitoneal/pericardial fluid by both the paramedics and the PO. FAST and AA US exam interpretation by the paramedics had a 100% proportion of agreement with the PO.

Conclusions:  This pilot study shows that with close supervision, paramedics can adequately obtain and interpret prehospital FAST and AA US images under protocol. These results support a growing body of literature that indicates US may be feasible and useful in the prehospital setting.

ACADEMIC EMERGENCY MEDICINE 2010; 17:624–630 © 2010 by the Society for Academic Emergency Medicine

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