Particularly with critical time-sensitive emergencies, the more information EMS can provide before or as it hands over patient care at the ED, the better. In cases of trauma, that's a primary argument for prehospital ultrasound.
North Carolina's Iredell County EMS was the state's first ground service with that capability, and leaders saw immediately how it could benefit patients.
"The name of the game here is information," says Howard Mell, MD, the medical director who oversaw the rollout. "And the more information you can provide so the ED can be ready to receive a critically ill patient, the better off that patient is. Look at any of the things we're discussing in emergency medicine and EMS right now: sepsis, STEMI, stroke, trauma--they're all about getting information to identify the sickest patients so we can manage their care more appropriately. And that's where ultrasound comes into play."
Iredell County brought ultrasound to the field via the uSmart 3200T from Terason. It's a lightweight (less than 5 lbs.), portable and durable device that can accept a variety of probes, suiting it not only for simple trauma exams like FAST but other applications as well. In Iredell it's powered extended FAST exams, pregnancy assessments in obtunded trauma patients and assessment of cardiac motion to guide CPR.
"There were three things I liked about the Terason that I couldn't find elsewhere," says Mell. "One, it was the most portable that gave us full features. Another was the ability to easily upload and transmit the images. We never got to the point of doing a full transmit, but I used that to do QI/QA. And third, the Terason folks were amazing to work with. They really stood behind their product."
An important distinction for EMS venturing into ultrasound, Mell counsels, is full-service versus non-full-service devices.
"There's a world of difference between the Terason system and a handheld unit with one probe and limited screen size," he says. He believes new users may struggle to get good results with the limited functionality of some portable systems, and that they won't benefit as their skills develop and the uses for ultrasound expand. "That," he says, "should be what EMS is looking for."