Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-19T16:35:41.926Z Has data issue: false hasContentIssue false
  • English
  • Français

Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit

Published online by Cambridge University Press:  03 May 2017

Domhnall O’Dochartaigh Open the ORCID record for Domhnall O’Dochartaigh [Opens in a new window] ,
Matthew Douma ,
Chris Alexiu ,
Shell Ryan  and
Mark MacKenzie
Domhnall O’Dochartaigh*
Affiliation:
Alberta Health Services, Emergency, Edmonton Zone, Alberta, Canada Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada
Matthew Douma
Affiliation:
Alberta Health Services, Emergency Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
Chris Alexiu
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
Shell Ryan
Affiliation:
Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada
Mark MacKenzie
Affiliation:
Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada Alberta Health Services Emergency Medical Services, Edmonton, Alberta, Canada
*
Correspondence: Domhnall O’Dochartaigh, RN, MSc Room 1G1-55 Department of Emergency Medicine University of Alberta Hospital Edmonton, Alberta, Canada T6G 2B7 E-mail: domhnall.odochartaigh@ahs.ca; dodochartaigh@stars.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Prehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.

Problem

Which patients may benefit from PHUS has not been clearly identified.

Methods

A multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of “PHUS-supported intervention.”

Results

Both models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR=15.86 [95% confidence interval (CI), 1.46-171.73]; P=.02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to<1.3: OR=9.15 [95% CI, 1.36-61.69]; P=.02; and SI 1.3+: OR=8.37 [95% CI, 0.69-101.66]; P=.09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR=13.36 [95% CI, 1.92-92.81]; P=.008; and PHI 20-24: OR=53.10 [95% CI, 4.83-583.86]; P=.001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to<1.3: OR=9.11 [95% CI, 1.31-63.32]; P=.025; and SI 1.3+: OR=35.75 [95% CI, 2.51-509.81]; P=.008).

Conclusions:

In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.

O’DochartaighD, DoumaM, AlexiuC, RyanS, MacKenzieM. Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit. Prehosp Disaster Med. 2017;32(5):536–540.

Keywords

air ambulanceFASTHEMSPOCUSultrasound
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 5 , October 2017 , pp. 536 - 540
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. O’Dochartaigh, D, Douma, M. Prehospital ultrasound of the abdomen and thorax changes trauma patient management: a systematic review. Injury. 2015;46(11):2093-2102.CrossRefGoogle ScholarPubMed
2. Rudolph, SS, Sorensen, MK, Svane, C, Hesselfeldt, R, Steinmetz, J. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients - a systematic review. Resuscitation. 2014;85(1):21-30.CrossRefGoogle ScholarPubMed
3. O’Dochartaigh, D, Douma, M, MacKenzie, M. Five-year retrospective review of physician- and non-physician-performed ultrasound in a Canadian critical care Helicopter Emergency Medical Service. Prehosp Emerg Care. 2017;21(1):24-31.CrossRefGoogle Scholar
4. Taylor, J, McLaughlin, K, McRae, A, Lang, E, Anton, A. Use of prehospital ultrasound in North America: a survey of Emergency Medical Services medical directors. BMC Emerg Med. 2014;14:6.CrossRefGoogle ScholarPubMed
5. Lanctôt, J, Lanctôt, MV, Yanick, B. EGLS: echo-guided life support: an algorithmic approach to undifferentiated shock. Crit Ultrasound J. 2011;3(3):123-129.CrossRefGoogle Scholar
6. Rady, M, Smithline, H, Blake, H, et al. A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med. 1994;24(4):685-690.CrossRefGoogle ScholarPubMed
7. Koehler, JJ, Baer, LJ, Malafa, SA, Meindertsma, MS, Navitskas, NR, Huizenga, JE. Prehospital Index: a scoring system for field triage of trauma victims. Ann Emerg Med. 1986;15(2):178-182.CrossRefGoogle ScholarPubMed
8. Breitkreutz, R, Price, S, Steiger, HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010;81(11):1527-1533.CrossRefGoogle ScholarPubMed
9. Bodnar, D, Rashford, S, Hurn, C, et al. Characteristics and outcomes of patients administered blood in the prehospital environment by a road based trauma response team. Emerg Med J. 2014;31(7):583-588.CrossRefGoogle ScholarPubMed
10. Sherren, PB, Reid, C, Habig, K, Burns, BJ. Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staffed Helicopter Emergency Medical Service. Critical Care. 2013;17(2):308.CrossRefGoogle Scholar
11. Mrochuk, M, O’Dochartaigh, D, Chang, E. Rural trauma patients cannot wait: tranexamic acid administration by Helicopter Emergency Medical Services. Air Med J. 2015;34(1):37-39.CrossRefGoogle ScholarPubMed