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Utility of Different Lung Ultrasound Simulation Modalities Used by Paramedics during Varied Ambulance Driving Conditions

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  28 October 2020

Lauren M. Maloney Open the ORCID record for Lauren M. Maloney [Opens in a new window] ,
Daryl W. Williams ,
Lindsay Reardon ,
R. Trevor Marshall ,
Andrus Alian ,
Jess Boyle  and
Michael Secko
Lauren M. Maloney*
Affiliation:
Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New YorkUSA
Daryl W. Williams
Affiliation:
Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New YorkUSA
Lindsay Reardon
Affiliation:
Since study initiation, Dr. Reardon has changed affiliations and is now at: University of Vermont Medical Center, Department of Emergency Medicine, Burlington, VermontUSA
R. Trevor Marshall
Affiliation:
Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New YorkUSA
Andrus Alian
Affiliation:
Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New YorkUSA
Jess Boyle
Affiliation:
Since study initiation, Mr. Boyle has changed affiliations and is now at: Stony Brook University, School of Health Technology and Management, Stony Brook, New YorkUSA
Michael Secko
Affiliation:
Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New YorkUSA
*
Correspondence: Lauren M. Maloney, MD, NRP, FP-C, NCEE Stony Brook University Hospital Department of Emergency Medicine HSC Level 4 Room 050 Stony Brook, New York11794-8350USA E-mail: [email protected]
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Abstract

Introduction:

Prehospital use of lung ultrasound (LUS) by paramedics to guide the diagnoses and treatment of patients has expanded over the past several years. However, almost all of this education has occurred in a classroom or hospital setting. No published prehospital use of LUS simulation software within an ambulance currently exists.

Study Objective:

The objective of this study was to determine if various ambulance driving conditions (stationary, constant acceleration, serpentine, and start-stop) would impact paramedics’ abilities to perform LUS on a standardized patient (SP) using breath-holding to simulate lung pathology, or to perform LUS using ultrasound (US) simulation software. Primary endpoints included the participating paramedics’: (1) time to acquiring a satisfactory simulated LUS image; and (2) accuracy of image recognition and interpretation. Secondary endpoints for the breath-holding portion included: (1) the agreement between image interpretation by paramedic versus blinded expert reviewers; and (2) the quality of captured LUS image as determined by two blinded expert reviewers. Finally, a paramedic LUS training session was evaluated by comparing pre-test to post-test scores on a 25-item assessment requiring the recognition of a clinical interpretation of prerecorded LUS images.

Methods:

Seventeen paramedics received a 45-minute LUS lecture. They then performed 25 LUS exams on both SPs and using simulation software, in each case looking for lung sliding, A and B lines, and seashore or barcode signs. Pre- and post-training, they completed a 25-question test consisting of still images and videos requiring pathology recognition and formulation of a clinical diagnosis. Sixteen paramedics performed the same exams in an ambulance during different driving conditions (stationary, constant acceleration, serpentines, and abrupt start-stops). Lung pathology was block randomized based on driving condition.

Results:

Paramedics demonstrated improved post-test scores compared to pre-test scores (P <.001). No significant difference existed across driving conditions for: time needed to obtain a simulated image; clinical interpretation of simulated LUS images; quality of saved images; or agreement of image interpretation between paramedics and blinded emergency physicians (EPs). Image acquisition time while parked was significantly greater than while the ambulance was driving in serpentines (Z = -2.898; P = .008). Technical challenges for both simulation techniques were noted.

Conclusion:

Paramedics can correctly acquire and interpret simulated LUS images during different ambulance driving conditions. However, simulation techniques better adapted to this unique work environment are needed.

Keywords

EMSlung ultrasoundparamedicsimulationthoracic ultrasound
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 42 - 46
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Botker, MT, Jacobsen, L, Rudolph, SS, Knudsen, L. The role of point of care ultrasound in prehospital critical care: a systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):51.CrossRefGoogle ScholarPubMed
Ketelaars, R, Reijnders, G, van Geffen, GJ, Scheffer, GJ, Hoogerwerf, N. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J. 2018;10(1):17.CrossRefGoogle ScholarPubMed
Lichtenstein, D, Meziere, G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med. 1998;24(12):1331-1334.CrossRefGoogle ScholarPubMed
Liteplo, AS, Marill, KA, Villen, T, et al. Emergency Thoracic Ultrasound in the Differentiation of the Etiology of Shortness of Breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med. 2009;16(3):201-210.CrossRefGoogle ScholarPubMed
Neesse, A, Jerrentrup, A, Hoffmann, S, et al. Prehospital chest emergency sonography trial in Germany: a prospective study. Eur J Emerg Med. 2012;19(3):161-166.CrossRefGoogle ScholarPubMed
Laursen, CB, Hanselmann, A, Posth, S, Mikkelsen, S, Videbaek, L, Berg, H. Prehospital lung ultrasound for the diagnosis of cardiogenic pulmonary oedema: a pilot study. Scand J Trauma Resusc Emerg Med. 2016;24:96.CrossRefGoogle Scholar
Zanatta, M, Benato, P, De Battisti, S, Pirozzi, C, Ippolito, R, Cianci, V. Prehospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile? Crit Ultrasound J. 2018;10(1):22.CrossRefGoogle Scholar
Rempell, JS, Noble, VE. Using lung ultrasound to differentiate patients in acute dyspnea in the prehospital emergency setting. Crit Care. 2011;15(3):1.CrossRefGoogle ScholarPubMed
Volpicelli, G. Lung sonography. J Ultrasound Med. 2013;32(1):165-171.CrossRefGoogle ScholarPubMed
Volpicelli, G, Elbarbary, M, Blaivas, M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-591.CrossRefGoogle ScholarPubMed
Brooke, M, Walton, J, Scutt, D, Connolly, J, Jarman, B. Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naive advanced paramedics: trialing a PHUS education programme. Emerg Med J. 2012;29(4):322-326.CrossRefGoogle Scholar
Chuang, TJ, Lai, CC. Sonographic barcode sign of pneumothorax. QJM. 2017;110(8):525-526.CrossRefGoogle ScholarPubMed
Lichtenstein, DA, Meziere, GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure. CHEST. 2008;134(1):117-125.CrossRefGoogle Scholar
Lichtenstein, DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. CHEST. 2015;147(6):1659-1670.CrossRefGoogle ScholarPubMed
Blaivas, M, Tsung, JW. Point-of-care sonographic detection of left endobronchial main stem intubation and obstruction versus endotracheal intubation. J Ultrasound Med. 2008;27(5):785-789.CrossRefGoogle ScholarPubMed
Quick, JA, Uhlich, RM, Ahmad, S, Barnes, SL, Coughenour, JP. In-flight ultrasound identification of pneumothorax. Emerg Radiol. 2016;23(1):3-7.CrossRefGoogle ScholarPubMed
Weaver, B, Lyon, M, Blaivas, M. Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign. Acad Emerg Med. 2006;13(3):239-244.CrossRefGoogle ScholarPubMed
Nelson, BP, Melnick, ER, Li, J. Portable ultrasound for remote environments, Part II: current indications. J Emerg Med. 2011;40(3):313-321.CrossRefGoogle ScholarPubMed
Zechner, PM, Breitkreutz, R. Ultrasound instead of capnometry for confirming tracheal tube placement in an emergency? Resuscitation. 2011;82(10):1259-1261.CrossRefGoogle ScholarPubMed
Blaivas, M, Lyon, M, Duggal, S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12(9):844-849.CrossRefGoogle Scholar
Kirkpatrick, AW, Sirois, M, Laupland, KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraxes: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma Acute Care Surg. 2004;57(2):288-295.CrossRefGoogle Scholar
Lichtenstein, D, Meziere, G, Biderman, P, Gepner, A, Barre, O. The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Resp Crit Care Med. 1997;156(5):1640-1646.CrossRefGoogle ScholarPubMed
Madill, JJ. In-flight thoracic ultrasound detection of pneumothorax in combat. J Emerg Med. 2010;39(2):194-197.CrossRefGoogle ScholarPubMed
Roline, CE, Heegaard, WG, Moore, JC, et al. Feasibility of bedside thoracic ultrasound in the helicopter emergency medical services setting. Air Med J. 2013;32(3):153-157.CrossRefGoogle ScholarPubMed
Raio, CC, Modayil, V, Cassara, M, et al. Can emergency medical services personnel identify pneumothorax on focused ultrasound examinations? Crit Ultrasound J. 2009;1(2):65-68.CrossRefGoogle Scholar
Picano, E, Frassi, F, Agricola, E, Gligorova, S, Gargani, L, Mottola, G. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr. 2006;19(3):356-363.CrossRefGoogle ScholarPubMed
Lyon, M, Walton, P, Bhalla, V, Shiver, SA. Ultrasound detection of the sliding lung sign by prehospital critical care providers. Am J Emerg Med. 2012;30(3):485-488.CrossRefGoogle ScholarPubMed
Bhat, SR, Johnson, DA, Pierog, JE, Zaia, BE, Williams, SR, Gharahbaghian, L. Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): point-of-care ultrasound in Emergency Medical Services. West J Emerg Med. 2015;16(4):503-509.CrossRefGoogle ScholarPubMed
Pietersen, PI, Madsen, KR, Graumann, O, Konge, L, Nielsen, BU, Laursen, CB. Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training. Crit Ultrasound J. 2018;10(1):23.CrossRefGoogle ScholarPubMed
Ketelaars, R, Hoogerwerf, N, Scheffer, GJ. Prehospital chest ultrasound by a Dutch helicopter emergency medical service. J Emerg Med. 2013;44(4):811-817.CrossRefGoogle ScholarPubMed
Lyon, M, Shiver, SA, Walton, P. M-mode ultrasound for the detection of pneumothorax during helicopter transport. Am J Emerg Med. 2012;30(8):1577-1580.CrossRefGoogle ScholarPubMed
National Association of State EMS Officials. National EMS Scope of Practice Model 2019 (Report No. DOT 812-666). Washington, DC USA: National Highway Traffic Safety Administration.Google Scholar
National Highway Traffic Safety Administration. National EMS Scope of Practice Model. https://www.ems.gov/pdf/education/EMS-Education-for-the-Future-A-SystemsApproach/National_EMS_Scope_Practice_Model.pdf. Accessed June 2020.Google Scholar
Snaith, B, Hardy, M, Walker, A. Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes. Emerg Med J. 2011;28(12):1063-1065.CrossRefGoogle ScholarPubMed
Chin, EJ, Chan, CH, Mortazavi, R, et al. A pilot study examining the viability of a prehospital assessment with ultrasound for emergencies (PAUSE) protocol. J Emerg Med. 2013;44(1):142-149.CrossRefGoogle ScholarPubMed