Clinical accuracy and timeliness are essential for successful decision-making and problem-solving in out-of-hospital medical care. The prehospital use of ultrasonography can improve initial data gathering, which enhances the delivery of acute care in a timely and effective fashion.
Emergency ultrasound has greatly improved patient care since the first published reports by emergency physicians. Emergency ultrasound has been shown to reduce morbidity and mortality in critically ill patients, and multiple studies have shown that it can be efficiently and effectively performed by clinicians, provided that adequate training and quality assurance programs are in place.
Over the last decade, investigators have begun evaluating the use of ultrasound in a wide variety of prehospital, civilian, and military settings. Several case studies and case series have suggested that its use is cost-effective and enhances care. Ongoing prospective studies are providing additional evidence of its impact on patient management (clinical effectiveness) and on the overall service and health care system performance (organizational and social effectiveness). Efforts are being made to identify its most appropriate applications in the prehospital setting, the technical feasibility and reliability of its use, prehospital provider training and competency requirements, and the impact of prehospital ultrasound on patient outcomes and community health.
To highlight the growing evidence in support of prehospital ultrasound, this chapter will review the overall applications undergoing studies throughout the world, focusing on the experience of the German, French, Italian, and American helicopter and ground-based emergency medical services (EMS).
The term “out-of-hospital ultrasound” refers to sonographic examinations performed in a wide variety of settings outside of traditional hospital departments, laboratories, and freestanding imaging centers. “Prehospital ultrasound” is synonymous, even though this term is mostly used in reference to EMS and tactical medicine applications. Prehospital ultrasound examinations are generally not performed by radiologists or sonographers; caregivers incorporate the use of ultrasound into the initial patient assessment at the point of care in the prehospital setting. The images obtained provide real-time morphologic and functional clinical information.
In the current emergency and critical care literature, “point-of-care ultrasound” most commonly refers to “bedside emergency ultrasound” since the scientific debate has been originally focused on patients being cared for in the emergency department; the resuscitation, operative, or recovery room; the intensive care unit; the medical imaging department; or other medical and surgical wards. Diagnostic and therapeutic advances have allowed “critical care” to be taken outside of the hospital setting to the scene of illness and injury in a wide variety of settings (Table 4-1)
Table 4‐1. Out‐of-Hospital Ultrasound Settings and Providers |Favorite Table|Download (.pdf)
Table 4‐1. Out‐of-Hospital Ultrasound Settings and Providers
Prehospital EMS care
Aboard helicopters, planes, ambulances
Mass casualties and disaster medicine
Car, train, air accidents
Explosions, terrorist attacks
Remote, austere and wilderness medicine
Mountain, rural, forest, desert areas