After being bitten by the ultrasound bug at SMACC, I have been stewing over this question for a while now: how can I contribute to this amazing group of EMS professionals? Especially when I loathe the thought of writing and I don’t have easy access to ground breaking material?
I have come across some resistance though and it’s pretty much the same response when I bring up the idea of EMS POCUS:
“It won’t change your treatment”
I beg to differ. I am a Flight Paramedic based in Juneau, Alaska. My closest level II trauma center is in Anchorage. My level I is in Seattle, Washington. My scope of practice includes chest tubes, ABG analysis with the i-STAT, and thrombolytics. This is not just another toy that I want to play with (okay, maybe just a little). This can change my treatment; it’s just a matter of logistics.
My immediate service area is comparable to the size of Georgia, and be dispatched to retrieve a patient anywhere in Alaska. Transport times are measured in hours, not minutes. We have a saying in our service; “we don’t have the golden hour, we have the golden day.” I have the ability to bypass local hospitals with limited resources. The rural communities that I serve do some amazing work with some really sick patients. Clinician levels range from basic medical training to physician with mostly mid-level providers in the clinics I serve. And not all clinics have the ability to shoot an X-ray.
Last month I had trauma patient at a clinic with a possible pelvic fracture. The clinic has the ability to take portable X-rays, they are hoping to get a CT machine in the future. We transported her to the nearest pre-arranged facility like a good flight crew. I later learned that she had received a CT and they shipped her to Seattle for surgical intervention. What if I could have identified internal injuries, saved time and radiation exposure? What if I could have had a jet on standby to expedite the patient’s transport to Seattle?
What about the fragile cardiac patient that seems to have an elusive medical history? Lets check out contractility and fluid volume level! Did a pneumothorax develop or worsen in flight? After reassessing our equipment, lets take a peek! Possible nephritis or kidney stones? Lets treat accordingly. Possible PE? Is there a clot hanging out in that RV?
Yes, ultrasound has the potential to change my treatment and make me a better provider.