Cranial ultrasound image acquisition in a moving ambulance feasibility for pre-hospital EMS applications: A review of literature
Benjamin Malinda1, Aarti Sarwal2, Sahil Kapoor3
1Campbell University School of Osteopathic Medicine, 2Medical Center Blvd, 3Atrium Health Wake Forest Baptist Medical Center
Objective:
Investigate available literature for the use of prehospital ultrasound for neurological indications.
Background:
Ultrasound is an invaluable resource for rapid diagnosis in the hospital setting. With the advent of handheld devices, it is an ideal imaging modality in the prehospital setting. It is affordable, easily placed on ambulances, and now within the scope of non-physician emergency medical providers. Data demonstrates that earlier intervention is key to improving patient outcomes with intracranial pathologies like hemorrhage. Ultrasound could play a vital role in the early detection and treatment of intracranial pathologies in the prehospital setting.
Design/Methods:
A systematic literature review was completed to find studies examining the role of point-of-care ultrasound in the prehospital setting for a neurological indication. Studies included those with human subjects that underwent ultrasound imaging. Imaging was completed by EMTs either in the field or while in transit to the hospital, by ambulance or helicopter. Studies where imaging was completed by someone other than an EMT in the field were excluded.
Results:
Ten studies met the inclusion criteria noted above. Only one demonstrated the use of ultrasound for a neurological indication. Nine studies showed EMTs were capable of providing consistent images in the field. One found lung scans acquired by EMTs inadequate. In all studies, images captured in the field were compared to repeat imaging by physicians in the hospital or standard hospital imaging modalities such as CT. Various methods were employed to educate EMTs on using and interpreting ultrasound, including lectures, pre and post-assessments, and ongoing education modules.
Conclusions:
Handheld ultrasound performed by EMTs in a moving ambulance is intuitive, accessible, and has been shown to be capable of providing consistent images. Further studies are needed to understand the potential application of ultrasound for neurological indications in the prehospital setting.