Educational standards for training paramedics in ultrasound: a scoping review

Ben Meadley, Alexander Olaussen, Ashleigh Delorenzo, Nick Roder, Caroline Martin, Toby St Clair, Andrew Burns, Emma Stam, Brett Williams, Ben Meadley, Alexander Olaussen, Ashleigh Delorenzo, Nick Roder, Caroline Martin, Toby St Clair, Andrew Burns, Emma Stam, Brett Williams

Abstract

Background: Paramedic-performed out-of-hospital ultrasound is a novel skill that has gained popularity in some services in recent years. In this setting point-of care ultrasound (POCUS) can provide additional information that can assist with management and guide transport to the most appropriate facility. We sought to explore the different educational approaches used for training paramedics in ultrasound in the out-of-hospital setting.

Methods: Ovid MEDLINE, EMBASE, EBM Reviews, The Cochrane Library, CINAHL plus, The Monash University Research Repository and the British Thesis Library were searched from the 1st of January 1990 to the 6th of April 2016. Google Scholar was searched and reference lists of relevant papers were examined to identify additional studies. Articles were included if they reported on out-of-hospital and POCUS educational approaches for paramedics.

Results: A total of 2002 unique articles were identified of which 18 articles met the inclusion criteria. Most articles reported combined cohorts of emergency providers with varying years of experience though most operators were POCUS naïve. The most common clinical assessment for which paramedic POCUS curricula was described was the focused assessment sonography for trauma (FAST) examination. Education programs varied from two-minutes to two-days with all studies including both didactic and practical training.

Conclusion: Education programs for POCUS for paramedics vary considerably, and do not appear to align with qualification level or clinical experience. Further research investigating education and subsequent clinical application of POCUS by paramedics is required, as well as prospective, outcome based studies in order to measure the clinical utility of out-of-hospital POCUS.

Keywords: Education; Out-of-hospital; Paramedic; Training; Ultrasound.

Figures

Fig. 1
Fig. 1
Flow diagram showing the identification of studies assessing POCUS educational approaches for paramedics

References

    1. Davison K, Forbes MP. Pre-hospital medicine: A glimpse of the future. Australasian J Paramedicine. 2015;12:5.
    1. El Sayed MJ, Zaghrini E. Prehospital Emergency Ultrasound: A Review of Current Clinical Applications, Challenges, and Future Implications. Emergency Medicine International. 2013.
    1. Jaffer U, Aslam M, Jaffer A, Standfield N, Pennell A. Emergency ultrasound in the prehospital setting. J Paramed Pract. 2011;3:83–86. doi: 10.12968/jpar.2011.3.2.83.
    1. Nelson BP, Chason K. Use of ultrasound by emergency medical services: a review. Int J Emerg Med. 2008;1:253–9. doi: 10.1007/s12245-008-0075-6.
    1. Nakahara S, Matsuoka T, Ueno M, Mizushima Y, Ichikawa M, Yokota J, Yoshida K. Predictive factors for undertriage among severe blunt trauma patients: what enables them to slip through an established trauma triage protocol? J Trauma Acute Care Surg. 2010;68:1044–51. doi: 10.1097/TA.0b013e3181aca144.
    1. Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, Marzi I. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg. 2006;93:238–42. doi: 10.1002/bjs.5213.
    1. Heegaard W, Plummer D, Dries D, Frascone R, Pippert G, Steel D, Clinton J. Ultrasound for the air medical clinician. Air Med J. 2004;23:20–23.
    1. Quick JA, Uhlich RM, Ahmad S, Barnes SL, Coughenour JP. In-flight ultrasound identification of pneumothorax. Emerg Radiol. 2016;23:3–7. doi: 10.1007/s10140-015-1348-z.
    1. McCallum J, Vu E, Sweet D, Kanji HD. Assessment of paramedic ultrasound curricula: A systematic review. Air Med J. 2015;34:360–8. doi: 10.1016/j.amj.2015.07.002.
    1. Aylwin CJ, Brohi K, Davies GD, Walsh MS. Pre-hospital and In-hospital thoracostomy: indications and complications. Ann R Coll Surg Engl. 2008;90:54–7. doi: 10.1308/003588408X242286.
    1. Davis K, Drey N, Gould D. What are scoping studies? A review of the nursing literature. Int J Nurs Stud. 2009;46:1386–400. doi: 10.1016/j.ijnurstu.2009.02.010.
    1. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:1. doi: 10.1186/1748-5908-5-69.
    1. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32. doi: 10.1080/1364557032000119616.
    1. Booth KL, Reed MJ, Brady S, Cranfield KR, Kishen R, Letham K, McAlpine G, Murray DB, Wilson EB, Wilson M, Short S. Training paramedics in focussed echo in life support. Eur J Emerg Med. 2015;22:430–5. doi: 10.1097/MEJ.0000000000000246.
    1. Brooke M, Walton J, Scutt D, Connolly J, Jarman B. Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naive advanced paramedics: trialling a PHUS education programme. Emerg Med J. 2012;29:322–6. doi: 10.1136/emj.2010.106484.
    1. Chin EJ, Chan CH, Mortazavi R, Anderson CL, Kahn CA, Summers S, Fox JC. A pilot study examining the viability of a prehospital assessment with ultrasound for emergencies (PAUSE) protocol. J Emerg Med. 2013;44:142–9. doi: 10.1016/j.jemermed.2012.02.032.
    1. Heiner JD, McArthur TJ. The ultrasound identification of simulated long bone fractures by prehospital providers. Wilderness Environ Med. 2010;21:137–40. doi: 10.1016/j.wem.2009.12.028.
    1. Unlüer EE, Yavaşi O, Kara PH, Kılıç TY, Vandenberk N, Kayayurt K, Kıyançiçek S, Akoğlu H, Yılmaz C. Paramedic-performed focused assessment with sonography in trauma (FAST) in the emergency department. Turkish J Trauma Emerg Surg. 2011;17:113–6. doi: 10.5505/tjtes.2011.88557.
    1. West B, Cusser A, Etengoff S, Landsgaard H, LaBond V. The use of fast scan by paramedics in mass-casualty incidents: A simulation study. Prehospital and Disaster Med. 2014;29:576. doi: 10.1017/S1049023X14001204.
    1. Baldaranov D, Kilic M, Pflug K, Theiss S, Leis A, Pemmerl J, Pels H, Boy S, Bogdahn U, Schlachetzki F. Prehospital stroke education in paramedics. Eur J Neurol. 2015;22:799.
    1. Lahham S, Rooney K, Sloane B, Fox JC. Prehospital assessment with ultrasound In emergencies-pause II. Acad Emerg Med. 2015;22:S227. doi: 10.1111/acem.12593.
    1. Knapp B, Byars D, Stewart V, Ryszkiewicz R, Evans D. Emergency medical services focused assessment with sonography in trauma and cardiac ultrasound in cardiac arrest: the training phase. Acad Emerg Med. 2012;19:S189. doi: 10.1111/j.1553-2712.2011.01270.x.
    1. 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;30:485–8. doi: 10.1016/j.ajem.2011.01.009.
    1. Press GM, Miller SK, Hassan IA, Blankenship R, del Junco D, Camp E, Holcomb JB. Evaluation of a training curriculum for prehospital trauma ultrasound. J Emerg Med. 2013;45:856–64. doi: 10.1016/j.jemermed.2013.05.001.
    1. Vitto MJ, Spector D, Evans DP. Implementation of a flight medical crew ultrasound training program. Acad Emerg Med. 2015;22:S133.
    1. Lema PC, Wilson J, O’brien M, Lindstrom H, Tanski C, Consiglio J, Clemency B. Ultrasound identification of successful endotracheal tube placement by paramedics and residents. Ann Emerg Med. 2014;64:S8. doi: 10.1016/j.annemergmed.2014.07.043.
    1. Roline CE, Heegaard WG, Moore JC, Joing SA, Hildebrandt DA, Biros MH, Caroon LV, Plummer DW, Reardon RF. Feasibility of bedside thoracic ultrasound in the helicopter emergency medical services setting. Air Med J. 2013;32:153–7. doi: 10.1016/j.amj.2012.10.013.
    1. Cappa AR, Minckler MR, Wyatt RG, Binger CW, Stolz U, Amini R, Adhikari S, Stolz L. 291 effect of ultrasound-guided peripheral intravenous catheter placement by nurses and paramedics on central line placement in the emergency department. Ann Emerg Med. 2015;66:S105. doi: 10.1016/j.annemergmed.2015.07.325.
    1. Noble VE, Lamhaut L, Capp R, Bosson N, Liteplo A, Marx JS, Carli P. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Educ. 2009;9:3. doi: 10.1186/1472-6920-9-3.
    1. Lapostolle F, Petrovic T, Lenoir G, Catineau J, Galinski M, Metzger J, Chanzy E, Adnet F. Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. Am J Emerg Med. 2006;24:237–42. doi: 10.1016/j.ajem.2005.07.010.
    1. Knox S. International and unifying standards of pre-hospital care. Irish J Paramed. 2016;1:2.
    1. Lewiss RE, Hoffmann B, Beaulieu Y, Phelan MB. Point‐of‐care ultrasound education. J Ultrasound Med. 2014;33:27–32. doi: 10.7863/ultra.33.1.27.
    1. Gogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P. Is basic emergency ultrasound training feasible as part of standard undergraduate medical education? J Surg Educ. 2010;67:152–6. doi: 10.1016/j.jsurg.2010.02.008.
    1. Mendiratta-Lala M, Williams T, De Quadros N, Bonnett J, Mendiratta V. The use of a simulation center to improve resident proficiency in performing ultrasound-guided procedures. Acad Radiol. 2010;17:535–540. doi: 10.1016/j.acra.2009.11.010.
    1. Wang EE, Quinones J, Fitch MT. Developing technical expertise in emergency medicine: The role of simulation in Procedural skill acquisition. Acad Emerg Med. 2008;15:1046–1057. doi: 10.1111/j.1553-2712.2008.00218.x.
    1. Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper D, Walker T, Myles P, Murray L, David T, Smith K, Patric I, Edington J, Bacon A, Rosenfield J, Judson R. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: A randomised controlled trial. Ann Surg. 2010;252:959–65. doi: 10.1097/SLA.0b013e3181efc15f.
    1. Brooke M, Walton J, Scutt D, Connolly J. Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature. Emerg Med J. 2010;27:702–7. doi: 10.1136/emj.2010.094219.

Source: PubMed

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