Perspectives on Implementation of Point of Care Ultrasound in Prehospital Patient Care

Background: Handheld point-of-care ultrasound (POCUS) devices offer potential benefits for enhancing patient care without causing delays in transporting patients to definitive care. This current study aims to assess the safety and effectiveness of POCUS used by paramedics in the prehospital setting alongside their standard assessment tools. Methods: This is a prospective longitudinal study from January 2022 and March of 2023. Eligible patients 18 years and older were categorized into two main groups: trauma or cardiac arrest. Trauma patients included those suspected of tension pneumothorax or intra-abdominal bleeding, while cardiac arrest patients were included regardless of etiology. Paramedics assessed and performed ultrasound exams based on their clinical judgment. Images were subsequently reviewed by an emergency physician trained in ultrasound interpretation, who evaluated the image quality and provided agreement or disagreement with the paramedics' interpretations. Results: In total, 92 patients were evaluated, and 41 patients with complete records were included for analysis. There are 24 cardiac arrest cases, which included 10 were noted to have cardiac activity on POCUS and the other 14 patients did not have cardiac activities on POCUS, and 17 were trauma. The agreement between paramedics’ interpretation and reviewing physicians’ interpretation ranged from 60% for those cardiac arrests with cardiac activities on POCUS, 78.6% for cardiac arrests without cardiac activities on POCUS, and 70.6% for trauma cases. Conclusions: These findings underscore the potential for paramedics, with appropriate training, to utilize ultrasound effectively in improving patient care for individuals suffering from traumatic injuries or in cardiac arrest. Clinical trial number: Not applicable. This is a prospective observational study. No intervention was applied to human subjects. This study was approved by the Institutional Review Board at Arrowhead Regional Medical Center (ARMC) with approval number 20-35.