Everything really IS bigger in Texas- even their tools for EMS. And by bigger I mean more awesome. According to JEMS, “The San Jacinto College Emergency Medical Technology (EMT) program will add ultrasound training to its curriculum to train students for on-site diagnostic work, saving precious time while transporting a patient to a hospital.”
How cool is that? I’m officially jealous!
JEMS goes on to say, “EMS is at an evolutionary point where more is needed to help diagnose medical situations in an effort to determine where patients will be transported, whether it’s to an emergency room, a 24-hour clinic, or a more advanced center like a Level 1 trauma center.”
On a personal level, while paying my way through PCP school I got employment as a standardized patient at NOSM (Northern Ontario Medical School). In short my job was to help train medical students on building patient rapport and improving their communication techniques. Usually I was handed a script, which I would memorize and act out while the med student responded to my information and emotional cues. Sometimes their training would include practicing ultrasounds or physical exams. I had more than one tender rib after a full day of ultrasound training. My job was awesome as an paramedic student because I got a really in depth look into what physicians are training to look for. It also helped improve my own questioning techniques. But my favorite part was learning the basics of ultrasound use. I was used as a “normal model” since all my insides are healthy and intact, but NOSM also brought in models who had various ailments and surgeries for the student’s to identify. The whole time I was assisting in their training I was thinking, “I could totally do this! This would be a cool tool for EMS!”
JEMS sums up some of the reasons ultrasound availability would be great in the back of an ambulance. “A paramedic could tell whether a woman is suffering from symptoms from appendicitis or an ectopic pregnancy, or determine patient injuries like compartment syndrome. Additionally, the ultrasound technology can be used to locate blood vessels, and facilitate in locating hard-to-find veins in patients who need intravenous (IV) fluids or medications.” The US national library of medicine boasts the EMS providers are even using portable ultrasound machines to “diagnose conditions such as pleural, peritoneal, and pericardial effusion and deep venous thrombosis. [So far] the performance of portable units has been investigated in many applications, including the focused assessment with sonography in trauma (FAST), echocardiography, and aorta evaluations, among others…Several studies have examined the role that ultrasound may play in enhancing existing triage systems during multicasualty incidents.”
NLM goes on to state that, “The Italian EMS system began incorporating ultrasound into prehospital care in 2005. It is being investigated as an adjunct to triage and patient assessment as well as field management of illness. Helicopter and ground units in Milan are equipped with portable ultrasound devices, and three major clinical indications are being evaluated: cardiac arrest, torso trauma, and acute dyspnea. Prehospital ultrasound is employed in this setting to differentiate reversible causes of pulseless electrical activity (PEA)…and to differentiate between pulmonary edema and emphysema.” Not only can ultrasound use help differentiate between different pathologies, it can also influence pre-hospital treatment. “Ultrasound can impact care of patients with regards to fluid resuscitation and other management options.”
Prehospital ultrasounds would definitely help better allocate in-hospital resources. It would free up our already overworked physicians and decrease patient wait times for further diagnostics/treatment. And of course, most importantly, it will also improve patient outcome. Of course there are lots of issues such as service costs, training (although it doesn’t usually take more than 2 days), tech issues, space, storage, upkeep blah blah blah. For now I’m just going to think about how neat it would be to work in Texas or Italy. Where it’s warm.
Ps- if you want to buy me something for Christmas this year…..