Prehospital ultrasound: incidence of realization and impact on patient management

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.Advanced life support