Effectiveness of a Simulation-based Point-of-care Ultrasound Course for Prehospital Providers - A Single Group Quasi-Experimental Study

Objective Emergency medical service (EMS) professionals are increasingly using point-of-care ultrasound (POCUS) into the prehospital management and triage of critically ill patients. However, few institutions offer organized POCUS training for this community. Our goal was to offer and evaluate the effectiveness of a simulation-based POCUS course for EMS professionals. Methods We developed and implemented an eight-hour course to train EMS providers in the fundamentals of POCUS for blunt trauma patients. The course design included lectures, standardized patients hands-on scanning, simulation-based ultrasound cases, clinical cases based on real patients, and an end-of-course review game. Before the day of the course, participants were assigned e-learning modules on the fundamentals of POCUS and on the Extended Focused Assessment with Sonography for Trauma Exam (eFAST). The effectiveness of the course was evaluated using Kirkpatrick’s methodology for Level 1 (course evaluation by participants) and Level 2 (pre- and post-course knowledge assessments including image interpretation). Pre- and post-knowledge scores were presented using means and ranges. Percent improvements and a paired sample t-test with the effect size (Cohen’s d) were used to compare pre-post improvements. For course evaluation ratings, the mean Likert scale rating was calculated. Results A total of 128 learners (103 paramedics, 22 flight nurses, and one EMS physician from 32 EMS agencies, as well as two United States Army medics, completed the course. The average age of participants was 39.0 years, and 98 (76.6%) were male. The pre-course assessment mean knowledge score was 67.6% (95% CI 64.7–70.5). The post-course mean knowledge score was 89.0% (95% CI 87.3–97.0), resulting in the 21.4 percentage point increase (p < .001; Cohen’ s d  = 1.52). We received 122 course evaluations. Participants expressed nearly unanimous strong agreement across all measures, with a mean rating ranging from 4.8 to 4.9 on a 5-point Likert scale questionnaire. Conclusions Our data suggests that an 8-hour POCUS course, incorporating e-learning and simulation, can significantly improve EMS providers’ knowledge of the fundamentals of POCUS and image interpretation of eFAST examination in trauma patients. Course evaluation results are highly supportive of this course’s benefits. As EMS agencies increasingly incorporate POCUS for patient care, effective and efficient training methodologies will be critical for successful implementation. Our course offers one approach as part of a comprehensive training program. Further studies should assess POCUS utilization and sustained knowledge retention.