a pneumothorax and prehospital ultrasound might have prevented an
unnecessary invasive procedure and potential harm to the patient.
It’s important to note, however, that the minimum competency level
and number of scans required to achieve competency in prehospital
ultraound haven’t yet been established.
The American College of Emergency Physicians (ACEP) presents
a more firmly established parallel for resident physicians graduating
from accredited emergency medicine programs, recommending 25–50
cases per individual ultrasound application.
18 Although this may be a
challenging target to hit for EMS agencies implementing prehospital
ultrasound, it does represent a standard for best practice which may
warrant further investigation.
Initial ultrasound skill acquisition by paramedics is possible with relatively short training courses. Skill maintenance in ultrasonography, similar to other critical care skills, requires routine practice, good quality
assurance programs and physician oversight.
POCUS has become a standard of care in relatively short order
across EDs nationwide, with prehospital ultrasound becoming increasingly more common in Europe, where they’ve found ultrasound to be
valuable in the field.
Prehospital ultrasound has many clinical applications that may
reduce morbidity and potentially improve outcomes for patients with
In addition to helping a provider make an accurate and specific
diagnosis with accuracy, prehospital ultrasound also has the potential
to change treatment in the prehospital sphere, alter the destination or
receiving facility, as well as the potential to alter the receiving hospital
management of the critically ill or injured patient.
The initial adoption of this technology will likely be highest in critical care subsets of out-of-hospital providers, such as air medical and
ground critical care transport units, but potentially shows a broad-based
application in 9-1-1 emergency response at the ALS and BLS levels.
In addition to the need for further prospective outcomes research
examining potential algorithms, as well as their effect on patient morbidity and mortality, some EMS agencies and their medical directors
are concerned about the cost of ultrasound units and the need for additional training for their personnel.
The cost for portable ultrasound units has declined, and several
manufacturers now have, or will soon offer, ultrasound integrated into
their existing cardiac monitor packages. Like 12-lead education, services desiring to implement ultrasound into their clinical operation
should do so with proper training that ensures maximum effectiveness.
As with any new technology, it’s not the shiny new tool which leads to
benefit, but rather the upgrade to the provider’s medical decision-making algorithm. The ability to acquire otherwise invisible physiologic
and anatomic information about a critical patient at the scene simply
can’t be understated. JEMS
Faizan H. Arshad, MD, is EMS medical director for Vassar Brothers Hospital—Healthquest
Systems in Hudson Valley, NY. He’s also the founder of the EMS Nation podcast and is a member
of the JEMS editorial board. He recently launched the Prehospital Ultrasound (PHUS) Project,
a consultative service to assist in the successful launch of a PHUS program. To continue the
conversation on #PHUS, tweet him @emscritcare and visit
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Ultrasound Workshops at
For providers already committed to the technology and eager to begin
implementing prehospital ultrasound on their critically ill patients, Faizan
H. Arshad, MD, is teaching two half-day pre-conference workshops at
EMS Today 2018 in Charlotte, N.C., on Tuesday, Feb. 20.
Each workshop will feature high-impact didactics taking providers from
the nuts to bolts of implementing prehospital ultrasound. Live, hands-on
simulation with patient actors will take participants through the paces of the
heuristics of scanning using the latest, most rugged and portable devices.
A portion of time during each workshop will enable attendees to have
exclusive access to vendors and direct hands-on time with devices pre-selected for their adaptability to the out-of-hospital environment. Each
workshop is limited to 40 people. Register now at