Gregg Rice
Texas Tech University Health Sciences Center, Medical Education
Gregg Rice, MD has been practicing medicine using ultrasound as a Board Certified Diagnostic Radiologist for 18 years in combination with the other diagnostic medical imaging modalities including CT, MRI, fluoroscopy, nuclear medicine, and plain film radiography. Dr. Rice sees the tremendous value that point of care ultrasound brings to patient care, particularly in the context of telemedicine. He grew up in Lubbock and graduated from Monterey High School and Texas Tech University and then attended UT Southwestern Medical School and completed a Diagnostic Radiology residency and Nuclear Medicine fellowship at UTSW. Dr. Rice is grateful to have built quality relationships at Texas Tech University Health Sciences Center and is delighted with the opportunity to bring differentiated experience and collaborative thought leading as a team member with Dr. Billy Philips at the F. Marie Hall Institute of Rural and Community Health and contribute to the care of West Texans.
Billy U. Philips, Jr., PhD, MPH, and the Texas Tech University Health Sciences Center (TTUHSC) F. Marie Hall Institute for Rural and Community Health (FMHIRCH), along with partners Vaughan Lee, PhD, Assistant Dean, TTUSHC... [ view full abstract ]
Billy U. Philips, Jr., PhD, MPH, and the Texas Tech University Health Sciences Center (TTUHSC) F. Marie Hall Institute for Rural and Community Health (FMHIRCH), along with partners Vaughan Lee, PhD, Assistant Dean, TTUSHC School of Medicine, and Gregg Rice, MD, Adjunct Assistant Professor, TTUHSC Department of Medical Education and Staff Diagnostic Radiologist, VA North Texas Health Care System, would like to educate and train Emergency Medical Services (EMS) personnel to use Point of Care Ultrasound (PoCUS) to perform the Focused Assessment with Sonography for Trauma (FAST) exam, and train Emergency Medicine (EM) Directors and Physicians in the receiving facilities on how best to guide the use of this technology in the field.
Response and transport times for major trauma incidents are longer in rural areas compared with urban areas. Acute trauma patients in West Texas, particularly those who are hemodynamically unstable, are at significant increased risk as compared to urban patients. Medical literature has shown that there is a significant increased relative risk of mortality (up to two-times greater) of rural motor vehicle collision (MVC) drivers as compared to non-rural MCV drivers.
In West Texas, the nearest medical facility can be up to 1.5 hours away by ambulance. Frequently, there is only one EMS service available in a 50-to-100-mile radius, which can mean devastating results for those with time-sensitive, life-threatening injury.
Evidence shows that “FAST may be useful in the evaluation of solid-organ injury and in the triage of multiple or mass casualty incidents” (American Institute of Ultrasound in Medicine [AIUM] Practice Parameters, 2014). It is felt that early prehospital detection of free intraperitoneal fluid in the rural field setting with PoCUS could facilitate more confident decisions to use aeromedical transport over ground transport of trauma victims to a more distant Level I or Level II Trauma facility.
In accordance with the AIUM Practice Parameter for the Performance of the FAST exam, Dr. Philips, et al, propose to educate EMS personnel and EM Directors and Physicians participating in the Next Generation 9-1-1 Telemedicine Medical Services Pilot Project conducted by TTUHSC and the Texas Commission on State Emergency Communications. Education and training will be conducted at a partner institution, the University of Texas Health Science Center San Antonio (UTHSCSA) Center for Clinical Ultrasound Education (CCUE) with ultrasound education experts Nilam Soni, MD, and Craig Sisson, MD, RDMS, FACEP.
Training would include lecture, simulated learning, and competency-based hands-on training. Faculty at the UTHSCSA CCUE would confirm that EMS personal can successfully use PoCUS for FAST exams and that EM Directors and Physicians feel comfortable directing this activity remotely, sight unseen of the patient, using radio communication and ultrasound images. Follow-up skills checks, refresher courses, and additional learning would take place at the TTUHSC FMHIRCH Frontiers in Telemedicine Simulation Lab in Lubbock, Texas, to ensure continued competence.
With this technology and advanced training, the FAST exam would then be implemented and performed in the rural field setting throughout the Permian Basin in West Texas during severe acute traumatic incidents by paramedics who are guided by EM Physicians.
The potential opportunities are:
1. Improve patient care by bringing patient and physician together sooner, providing the right treatment at the right time, and accessing the need of care at the point of injury.
2. Provide better information and improved care communications by allowing data regarding patients to be seen by the physician, bringing about more effective treatment plans and collaborative practice between EMS and treating hospitals.
3. Improve patient outcomes and decrease cost as patients may be directed to a more appropriate treatment facility without screenings in hospital Emergency Departments before being transferred to a higher level of care.
Outcomes will be measured by the successful adoption of PoCUS by EMS personnel utilizing the FAST exam in the field, the ability to generate diagnostic quality sonographic images that can be transmitted quickly to the distant site provider for image interpretation, adoption of the new process by EM Directors and Physicians in Critical Access Hospitals throughout the Permian Basin, and timely medical decision-making for patient disposition.
The rapid diagnosis of the severity of injury and immediate triage to the optimal health care location can potentially reduce costs, decrease treatment time, and improve patient outcomes.
Point of Care ultrasound in health care delivery to underserved populations , Point of Care ultrasound in general clinical practice , Patient Safety
