Prehospital ultrasound: incidence of realization and impact on patient management

GONZVA J, DERKENNE C, ROBERT J, ALLONNEAU A, GELÉ V, HERVAULT N, MATHON A, LEFORT H, JOST D, TOURTIER JP. Prehospital ultrasound: incidence of realization and impact on patient management. Med Emergency, MJEM 2019; 27:4-6.
doi: 10.26738/MJEM.2017/MJEM27.2019/JG.OAE.210218

Key words: Advanced life support, prehospital emergency care, pre-hospital ultrasound, ultrasound

  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement

Correspondent author: Jonathan GONZVA, MD

Emergency Medicine Department, Fire Brigade of Paris

1 place Jules Renard, 75017 Paris, France

jonathan.gonzva@pompiersparis.fr

Gonzva J, MD1, Derkenne C, MD1, Robert J, MD1, Allonneau A, MD1, Gelé V1, Hervault N1, Mathon A1, Lefort H, MD2, Jost D, MD1, Tourtier JP, PhD1

1. Emergency Department, Fire Brigade of Paris, 1, place Jules Renard, 75017 Paris, France

2. Emergency Department, Military Teaching Hospital Legouest, 27 avenue de Plantières, 57070 Metz, France

Category: Original article

Received: Dec. 27, 2017

Revised: Jan. 24, 2018

Accepted: Feb. 21, 2018

There is no conflict of interest to declare

ABSTRACT

In a two-tiered pre-hospital emergency system, the miniaturization of ultrasound machines has allowed their increased use within Advanced Life Support teams in spite of a systematic absence of university education. A retrospective study in an urban area aimed to measure the incidence of pre-hospital ultrasound (PHU) performance. A secondary objective was reporting the reasons for carrying out PHU and its impact on patient management.

Over a one-year period, 3760 patients were taken charge of by an ALS team; 204 of them (5.4%) benefited from PHU. Pathologies involved were trauma (n = 130; 63.7%), chest pain (n = 32; 15.7%), cardiac arrest (n = 14; 6.9%), shock (n = 11; 5.4%), pregnancy (n = 5; 2.4%), and others (n = 12; 5.9%). There was no relationship between pathologic PHU and, respectively, the administration of a specific treatment (p = 0.13), or the decision to direct the patient to a particular department (p = 0.85).

The low incidence of performing PHU was explained essentially by the absence of systematic sonography training, and by the absence of specific pre-hospital guidelines. If PHU does not impact the management of a cohort in an urban milieu, it may influence hospital destination in a rural environment where the nearest hospitals are not always equipped with a complete technological platform. Additional investigations are needed on this topic. Training of emergency physicians in ultrasound must be reinforced.