Study Shows Prehospital Ultrasound Enhances Trauma Care Outcomes

In a recent study published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, researchers explored the implementation of prehospital point-of-care ultrasound (PoCUS) in a UK helicopter emergency medical service (HEMS). The study aimed to address the lack of governance structure and evidence of benefit associated with prehospital PoCUS.

The research team conducted a retrospective database review at London’s Air Ambulance (LAA) from September 2021 to March 2023. The PoCUS examinations were archived in a cloud-based server and reviewed weekly by expert clinicians. The scans were graded for adequacy, and feedback was provided to the clinicians for continuous learning. The study included a total of 628 scans, with clinicians performing scans for various conditions such as pneumothorax, free fluid, and pericardial effusions.

The majority of the patients scanned were male, with traumatic thoracic injuries being the most common. Paramedics performed a significant portion of the scans, demonstrating the utility of PoCUS in the prehospital setting. The study revealed a high level of agreement between clinicians and reviewers in diagnosing major pathologies, indicating the reliability of prehospital PoCUS when implemented with proper training and governance.

The introduction of a bespoke scanning protocol, the Pump, Pleura, and Pouring Blood (PPPB) protocol, allowed for a systematic evaluation of shock and assessment of heart function in critically injured trauma patients. The sensitivity and specificity of the PPPB protocol for diagnosing life-threatening injuries were promising, showing potential for improving patient outcomes in the prehospital setting.

Despite concerns about potential delays in patient care, the study found that PoCUS did not significantly impact on-scene time. Clinicians reported that PoCUS scans influenced their management decisions in a majority of cases, confirming the value of this technology in guiding clinical interventions.

Overall, the study highlighted the feasibility and reliability of prehospital PoCUS implementation in a HEMS service. The continuous feedback model, robust governance framework, and tailored training program were instrumental in ensuring high-quality ultrasound examinations in the prehospital environment. The findings suggest that prehospital PoCUS, when integrated effectively, can improve diagnostic accuracy and patient outcomes in trauma care.