Problems to anticipate when considering/using  Prehospital Ultrasound

 

Like the 12 lead ECG this tool will help us to "Rule In" some pathologies but it can't always "Rule Out". For instance a normal abdominal US scan does not mean that the patient is not bleeding into the abdomen. 

Ultrasound cannot image bowel and parts of the retroperitoneum very well. We can only look for bleeding but will not know the origin (usually).

Does not image solid organ injury (SOI) well. If the organ doesn't bleed you may have a normal exam.

Requires more knowledge and skill to use successfully and to its fullest advantage.

Increasing portability presents an interesting problem i.e. small screens are harder to read and often don't have a live video out connection.  We would need this to attach to a larger screen or to send live ultrasound images to the medical director.

There are many EDs that are not yet utilizing the E-FAST or RUSH exams.  Those folks may not be supporters of EMS getting it first. But look at how EMS took the lead on end tidal CO2 monitoring/capnography. Now ED's everywhere are looking to follow the EMS lead and add them to each critical care area.

Large patients may be very difficult, if not impossible to image on some exams. You can still look at lung slide and internal jugular veins on the morbidly obese. It may be the only way you would be able to find a vein and start an IV.

OK you got me; cost is still an overriding issue as health care faces increasing costs and flat-rate revenue. No one has a good answer yet with regards to how we fund this project but I believe that we should continue to strive in our efforts. Insurance companies often have research funds we may be able to tap. Maybe a grateful family member of a patient you cared for would want to donate towards the project.  Leasing a machine may be a good option. I know we generally don't like to consider used equipment but the decade old Sonosite 180plus is a great little machine.

Recently, thanks to intense competition, several vendors are selling and leasing systems at very reasonable and affordable prices!