• Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naive advanced paramedics: trialling a PHUS education programme

      Brooke, Mike; Walton, Julie; Scutt, Diane; Connolly, Jim; Jarman, Bob (2012-04)
      Objective This trial investigated whether advanced paramedics from a UK regional ambulance service have the ability to acquire and interpret diagnostic quality ultrasound images following a 2-day programme of education and training covering the fundamental aspects of lung ultrasound. Method The participants were tested using a two-part examination; assessing both their theoretical understanding of image interpretation and their practical ability to acquire diagnostic quality ultrasound images. The results obtained were subsequently compared with those obtained from expert physician sonographers. Results The advanced paramedics demonstrated an overall accuracy in identifying the presence or absence of pneumothorax in M-mode clips of 0.94 (CI 0.86 to 0.99), compared with the experts who achieved 0.93 (CI 0.67 to 1.0). In two-dimensional mode, the advanced paramedics demonstrated an overall accuracy of 0.78 (CI 0.72 to 0.83), compared with the experts who achieved 0.76 (CI 0.62 to 0.86). In total, the advanced paramedics demonstrated an overall accuracy at identifying the presence or absence of pneumothorax in prerecorded video clip images of 0.82 (CI 0.77 to 0.86), in comparison with the expert users of 0.80 (CI 0.68 to 0.88). All of the advanced paramedics passed the objective structured clinical examination and achieved a practical standard considered by the examiners to be equivalent to that which would be expected from candidates enrolled on the thoracic module of the College of Emergency Medicine level 2 ultrasound programme. Conclusion This trial demonstrated that ultrasoundnaive practitioners can achieve an acceptable standard of competency in a simulated environment in a relatively short period of time. https://emj.bmj.com/content/emermed/29/4/322.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emj.2010.106484
    • Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

      Brooke, Mike; Walton, Julie; Scutt, Diane (2010-07-28)
      ABSTRACT Objectives Recently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting evidence that prehospital ultrasound may reduce patient mortality and morbidity. The evidence available to inform this debate is almost entirely obtained from outside the UK, where emergency medical services (EMS) routinely use doctors as part of their model of service delivery. Using a structured review of the literature available, this paper examines the evidence to determine ‘Is there a place for paramedic ultrasound in the management of patients in the prehospital setting?’ Method A structured review of the literature to identify clinical trials which examined the use of ultrasound by non-physicians in the prehospital setting. Results Four resources were identified with sufficient methodological rigour to accurately inform the research question. Conclusion The theoretical concept that paramedicinitiated prehospital ultrasound may be of benefit in the management of critically ill patients is not without logical conceptual reason. Studies to date have demonstrated that with the right education and mentorship, some paramedic groups are able to obtain ultrasound images of sufficient quality to positively identify catastrophic pathologies found in critically ill patients. More research is required to demonstrate that these findings are transferable to the infrastructure of the UK EMS, and in what capacity they may be used to help facilitate optimal patient outcomes. https://emj.bmj.com/content/27/9/702.long This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ doi: 10.1136/bmj.h535
    • Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

      Brooke, Mike; Walton, Julie; Scutt, Diane (2010-07-28)
      Objectives Recently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting evidence that prehospital ultrasound may reduce patient mortality and morbidity. The evidence available to inform this debate is almost entirely obtained from outside the UK, where emergency medical services (EMS) routinely use doctors as part of their model of service delivery. Using a structured review of the literature available, this paper examines the evidence to determine ‘Is there a place for paramedic ultrasound in the management of patients in the prehospital setting?’ Method A structured review of the literature to identify clinical trials which examined the use of ultrasound by non-physicians in the prehospital setting. Results Four resources were identified with sufficient methodological rigour to accurately inform the research question. Conclusion The theoretical concept that paramedic-initiated prehospital ultrasound may be of benefit in the management of critically ill patients is not without logical conceptual reason. Studies to date have demonstrated that with the right education and mentorship, some paramedic groups are able to obtain ultrasound images of sufficient quality to positively identify catastrophic pathologies found in critically ill patients. More research is required to demonstrate that these findings are transferable to the infrastructure of the UK EMS, and in what capacity they may be used to help facilitate optimal patient outcomes. https://emj.bmj.com/content/27/9/702. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emj.2010.094219