Training Pre-Hospital First Responders on Point of Care Ultrasound to Improve Trauma Outcomes in Rural Settings: A Pilot Study

Introduction: Traditionally, trauma in rural settings has worse outcomes for patients and a much higher cost of care. While there are many factors that have been identified for this, access to care and speed of medical... [ view full abstract ]

Introduction:
Traditionally, trauma in rural settings has worse outcomes for patients and a much higher cost of care. While there are many factors that have been identified for this, access to care and speed of medical decision making has been the hardest to correct. Delays in triage and lack of resources to manage many types of injuries have led to transfers of patients over long distances and multiple changes in management. We sought to train first responders in point of care ultrasound to see if they would find it helpful in evaluating a trauma patient in the field and could be instituted as a technique to reduce triage time.

Methods:
First responders servicing a rural area took a course describing the pathophysiology and associated ultrasound findings of tension pneumothorax, cardiac tamponade, and hypovolemia. Following the didactic session, the participants were given hands on training on models with normal anatomy. Examples of abnormal finding were also provided to educate the students. A post-course survey was then done to assess interest, comfort, and knowledge of ultrasound in the trauma setting.
20 first responders participated in the curriculum. 8 participants were EMTs and all 20 were firefighters. The curriculum was run by medical students and overseen by a surgeon versed in ultrasound. Total time of training was 2 hours with ½ hour of didactic and the remaining used for hands on training.
Post curriculum surveys were scored on a 5 point Likert scale and comments were clustered into categories.

Results:
All 20 participants had minimal experience with ultrasound. None had used point of care ultrasound previously.
Post training 90% became comfortable with ultrasound and felt it would be a useful tool in the evaluation of a rural trauma patient. The majority of participants felt it would be useful in saving lives at the scene. 2 participants had difficulty with the ultrasound machine itself including the size of the screen and the image quality. A majority of students wanted more time with the machine to practice further. All participants were interested in further training in ultrasound including FAST exams, fracture evaluation, and line placement.

Conclusions:
In our pilot study 90% of first responders improved their understanding of point of care ultrasound. The majority of participants agree that application in a rural trauma setting will improve outcomes and reduce triage time for trauma victims.
We believe that in large rural areas first responders should be trained in point of care ultrasound and ultrasound should be employed in the evaluation of the trauma victim. With expanding use, image interpretation can be done by the trauma surgeon at regional centers with direct communication to the field.
Our ultimate goal will be to train first responders on the use of point of care ultrasound and connect image capture to the regional trauma service so immediate triage can begin in the field. Will connectivity of vitals and ultrasound to the regional center we believe that significant reduction of triage time and appropriate field transfer can be achieved. This will ultimately reduce mortality and morbidity for trauma victims in rural settings.