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 clinicians; 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 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 ED; the resuscitation, operative, or recovery room; the intensive care unit; the diagnostic 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
Critical care physicians/intensivists
Aboard helicopters, planes, ambulances
Mass casualties and disaster medicine
Sports Medicine physicians
Car, train, air crashes
Other “system-based” specialists
Explosions, terrorist attacks
Remote, austere, wilderness medicine
Mountain, rural, forest, desert areas
Cruise ships, air flights, space flights
Scarce-resource health services
Emergency medical technicians
Sports stadiums, Olympic Games
Primary health care
In all of these settings, ultrasonography provides a visual extension of the clinical examination, permitting more accurate assessment of anatomic and physiologic integrity in complex states of illness and injury (Figures 4-1 and 4-2). Prehospital applications are generally incorporated into defined problem-based clinical pathways rather than organ-based categorizations (i.e., “shock assessment” rather than “liver assessment”).
ABCD-conformed ultrasound applications in out-of-hospital setting.
Current level 1 ultrasound applications in out-of-hospital setting: ABCD-conformed pathways for the acute medical and surgical patient.
Clinical accuracy and timeliness are essential for successful decision making and problem-solving in the prehospital environment. The prehospital use of ultrasonography can improve initial data gathering, which enhances the delivery of acute care in a timely and effective fashion. 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.1–10