Using Ultrasound on the ambulance - Yes No Maybe?

[chbare]

I tend to agree with AZCEP on this one. I am simply not sure this would have an impact on patient care and outcome. Perhaps it will prove to be a great tool with triage decisions. Does this patient need a trauma center or can this other hospital care for the patient, may be such a situation. However, I have seen people with critical injuries have a negative FAST.

So, instead of asking why not, I think we need to ask why.

Take care,

chbare.

[VentMedic]

You know there is nothing wrong with getting a simple explanation of something so it makes sense. Why in the hell does everyone jump on Nancy Caroline for using plain English to help make a a point clear and easy to understand ( Your Sidney Sinus statement )? I get sick of people always acting like they read only the book with big words and never had anyone break something down to its basic simple meaning. I have seen the MD section at the book store, and yes they have some big books with words to big to fit on my belt but there are also simple plain english books there to that help them understand the big books. And God forbid I offend your Registered Ultrasound Technologists that I am positive never took and had to have someone or something explain something in simple poor folk talk how it really works. :roll: ].

As to the ultrasound. Why not use it? Perhaps it really would not change what we do as far as patient care most times, but it might allow us pre-hospital Healthcare Professionals ( or as edumacated folk call us simple folk, ambulance drivers) to give all the hospital Gods a heads up.

Now that is insulting to the Paramedic. Should a Paramedic not be able to understand a little more advanced medical procedure with real medical terminology? I think it is time this profession comes to grip with where the inconsistencies in education lies and fix this so it can converse with the "edumacated folk". It seems like whenever education is mentioned it is so much easier to bash those with education than to extend the effort to get educated themselves.

us simple folk, ambulance drivers

A new gadget is not going to instantly bring credibility to the profession. It can bring more scrutiny if not utilized properly.

Getting another "cert" in something else is not going to bring this profession in to the 21st century until some standards are established across the board.

And no I am no part of Odessa FD and their outdated in most cases protocols.

A FD with outdated protocols is venturing into this? That's a credible place to utilize US.

Let me explain about education. We're talking about explaining technical terms to people who are supposed to have some educational background in the medical sciences to understand some basic concepts for the technology. This is not about medical professionals being able to talk to the patient in simplistic terms. When I explain the straw concept of breathing to a patient, I do it in very simple terms. If I use that same straw concept for RN or RRT students, they had better be calculating the resistance and compliance factors for that straw from the technical data. There is an expectation of knowledge for the appropriate audience from their educational background in some basic sciences.

Other professionals (RNs, RRTs, CVTs etc) have ventured into US to aide in their occupations. It is not a far stretch when you have a few semesters of the sciences in your background to take a Survey of Anatomical Structures for US and understand it. If the course has to be dumbed down because not every Paramedic has the same educational background but rather just the 700 hour minimum to get their patch, that is a problem. Those that have taken more than just the bare minimum will probably not have much problem understanding medical terminology and will feel at ease conversing with other professionals about the procedure. Just as it stands, not every Paramedic is starting on the same level of education.

EMS has so many controversies now with just stabilizing an airway where even the ETCO2 monitor or the pulse ox is not adequately understood. Intubation competencies are not even being maintained in some services. We can also talk about RSI which many departments are not allowed to go there even in the trauma patient. 12 lead ECG interpretations come from the machines and not the Paramedic in some areas because "that extra education is too difficult to obtain".

This profession wants to "be like another profession" or get the same cert/patch that the other state next to it has but it has not concentrated on establishing its own identity yet with what it is doing with the "skills" and education it has now. I am aware of the future that may bring about the Paramedic Practioner someday but just adding a mish mash of "skills" is not going to bring the credibility the profession needs to obtain that goal.

I think this money could be better spent educating, training and supplying the equipment that will make an immediate difference or improve patient/crew safety.

Does this patient need a trauma center or can this other hospital care for the patient, may be such a situation. However, I have seen people with critical injuries have a negative FAST.

If the patient does go "negative FAST", what can you do about it in the truck other than what you are hopefully already doing? Are you going to rely on trying to get a "good picture" or will you start accessing and getting some treatment that is within your abilities started? Hopefully your assessment at scene of mechanism and vitals will give you enough information to notify the ED or Trauma center of what potential injuries you may have. You should also have some protocols in place for when to call for a helicopter or trauma alert.

[spenac]

Now that is insulting to the Paramedic. Should a Paramedic not be able to understand a little more advanced medical procedure with real medical terminology? I think it is time this profession comes to grip with where the inconsistencies in education lies and fix this so it can converse with the "edumacated folk". It seems like whenever education is mentioned it is so much easier to bash those with education than to extend the effort to get educated themselves.

A new gadget is not going to instantly bring credibility to the profession. It can bring more scrutiny if not utilized properly.

Getting another "cert" in something else is not going to bring this profession in to the 21st century until some standards are established across the board.

A FD with outdated protocols is venturing into this? That's a credible place to utilize US.

Let me explain about education. We're talking about explaining technical terms to people who are supposed to have some educational background in the medical sciences to understand some basic concepts for the technology. This is not about medical professionals being able to talk to the patient in simplistic terms. When I explain the straw concept of breathing to a patient, I do it in very simple terms. If I use that same straw concept for RN or RRT students, they had better be calculating the resistance and compliance factors for that straw from the technical data. There is an expectation of knowledge for the appropriate audience from their educational background in some basic sciences.

Other professionals (RNs, RRTs, CVTs etc) have ventured into US to aide in their occupations. It is not a far stretch when you have a few semesters of the sciences in your background to take a Survey of Anatomical Structures for US and understand it. If the course has to be dumbed down because not every Paramedic has the same educational background but rather just the 700 hour minimum to get their patch, that is a problem. Those that have taken more than just the bare minimum will probably not have much problem understanding medical terminology and will feel at ease conversing with other professionals about the procedure. Just as it stands, not every Paramedic is starting on the same level of education.

EMS has so many controversies now with just stabilizing an airway where even the ETCO2 monitor or the pulse ox is not adequately understood. Intubation competencies are not even being maintained in some services. We can also talk about RSI which many departments are not allowed to go there even in the trauma patient. 12 lead ECG interpretations come from the machines and not the Paramedic in some areas because "that extra education is too difficult to obtain".

I think this money could be better spent educating, training and supplying the equipment that will make an immediate difference or improve patient/crew safety.

If the patient does go "negative FAST", what can you do about it in the truck other than what you are hopefully already doing? Are you going to rely on trying to get a "good picture" or will you start accessing and getting some treatment that is within your abilities started? Hopefully your assessment at scene of mechanism and vitals will give you enough information to notify the ED or Trauma center of what potential injuries you may have.

And you missed the entire point being made that even doctors have books, instructors or others that break down subjects into easier to understand points. Then you build on that with the more in depth. I am 100% sure you did not just study the big book with the big words and understand everything. No I am 100% sure that you either also got an easier to understand simple book, had an instructor break it down, found an internet site, etc that made it easy to get the point. I am making a blanket statement that every student on some subject has needed a simple illustration in order to get the proper meaning of the big words in the big books. I am not saying you stop with the comic books, but use them to help you understand the point of the in depth books and it is ridiculous to claim they hurt the profession. What hurts the profession are the people that only rely on the simple w/o adding the in depth.

Now I do agree we need more education. For EMS use we would not be doing as definitive a look as you consider time constraints. Our use would be rapid exams for obvious major problems, that even I an uneducated moron could see and then tell the hospital so they would be better prepared upon our arrival. Yes I would prefer to have even a greater understanding of all I am seeing and yes at some point I will probably at my own expense take additional courses to get that education.

As to a patient going down fast no delays in care would be needed for US as hospital should already be expecting worst. But a MVA trauma patient with good vital signs could warrant a quick view to see if perhaps they have internal bleed after all initial interventions. Sadly I do see some idiots might go to the toys before treating the patient as is already seen in EMS but for those of us that are trying to ensure proper care why not be able to help expedite their care?

[VentMedic]

that even I an uneducated moron

Enough with the insulting name calling for the Paramedic in your reference to yourself. Poiniting out educational differences is very different from calling someone a moron.

And you missed the entire point being made that even doctors have books, instructors or others that break down subjects into easier to understand points. Then you build on that with the more in depth. I am 100% sure you did not just study the big book with the big words and understand everything. No I am 100% sure that you either also got an easier to understand simple book, had an instructor break it down, found an internet site, etc that made it easy to get the point.

I see you only read what you wanted to in my post. Let me recap:

Let me explain about education. We're talking about explaining technical terms to people who are supposed to have some educational background in the medical sciences to understand some basic concepts for the technology. This is not about medical professionals being able to talk to the patient in simplistic terms. When I explain the straw concept of breathing to a patient, I do it in very simple terms. If I use that same straw concept for RN or RRT students, they had better be calculating the resistance and compliance factors for that straw from the technical data. There is an expectation of knowledge for the appropriate audience from their educational background in some basic sciences.

Other professionals (RNs, RRTs, CVTs etc) have ventured into US to aide in their occupations. It is not a far stretch when you have a few semesters of the sciences in your background to take a Survey of Anatomical Structures for US and understand it. If the course has to be dumbed down because not every Paramedic has the same educational background but rather just the 700 hour minimum to get their patch, that is a problem. Those that have taken more than just the bare minimum will probably not have much problem understanding medical terminology and will feel at ease conversing with other professionals about the procedure. Just as it stands, not every Paramedic is starting on the same level of education.

Why do you think college level A&P, math and a few other science classes are required in the 2 year degree for other professionals? It introduces the students to medical and scientific terminology that might just be useful in their chosen or future professions. The 700 hour Paramedic program may not adequately prepare the student in the sciences including A&P. I hope you don't consider a college level A&P book too advanced for the Paramedic. College level classes expect the student to do a large amount of outside studying and research.

What hurts the profession are the people that only rely on the simple w/o adding the in depth.

This unfortunately the logic that so many have ignored by expanding the scope of practice with more "certs" to those with the minimum amount of education such as the 110 hour EMT-B into areas where there is little educational and knowledge base for them to draw upon.

But a MVA trauma patient with good vital signs could warrant a quick view to see if perhaps they have internal bleed after all initial interventions.

You're going to scan what and you are going to catch what? How good do you think you would have to be to pick up a small but potentially harmful bleeder in every area of the body. If you don't see something, are you going to say "all is well, I already did the US". That can be a false sense of security. That is why the hospital utilizes a quick CT scan. Most hospitals are capable of doing a CT Scan quickly.

[chbare]

Does this patient need a trauma center or can this other hospital care for the patient, may be such a situation. However, I have seen people with critical injuries have a negative FAST.

If the patient does go "negative FAST", what can you do about it in the truck other than what you are hopefully already doing? Are you going to rely on trying to get a "good picture" or will you start accessing and getting some treatment that is within your abilities started? Hopefully your assessment at scene of mechanism and vitals will give you enough information to notify the ED or Trauma center of what potential injuries you may have. You should also have some protocols in place for when to call for a helicopter or trauma alert.

I am not sure what you are asking. In my prior posts I thought I stated I really did not think doing a FAST exam would change the way I treat a patient. I thought it was implied that assessment of the scene, MOI, patient hemodynamics, LOC, and overall condition would be what I would use to guide my approach to patient care.

Take care,

chbare.

[spenac]

VentMedic to avoid wasting space I am a firm believer in additional education so EMS can advance.

Even with a great basis say even 4 year pre-med at times you will still need to have someone break things down on the simple. You can not tell me that once you complete those classes that from then on you do not need illustrations to help understand or recall material. I do not buy it. And I will make that another blanket statement.

As it seems me and you are misunderstanding each others points probably better I just drop it.

As to the US I do think we could benefit patients by becoming educated in using it. Is the course described enough, I doubt it but maybe? I do not feel that the way it would be used in EMS would require us to become RUT's. We would only be using it for a preliminary fast view. I would not expect that to be the end though. The hospital should still examine more thoroughly.

I am extremely aggressive in treating patients and am not satisfied with the well wait for the hospital because it would not change your treatment in the field argument. Everything we do extra in identifying problems early benefits the patients future. Now maybe I look at things differently because I am the patients only care for long periods of time but doing the minimum is wrong. I say continue getting education even if it is only small tid bits at a time, because then at least you are moving forward. Then as you continue to get education expand your patient care.

[VentMedic]

I am not sure what you are asking. In my prior posts I thought I stated I really did not think doing a FAST exam would change the way I treat a patient. I thought it was implied that assessment of the scene, MOI, patient hemodynamics, LOC, and overall condition would be what I would use to guide my approach to patient care.

Based on your initial assessment from scene and patient, would you have enough to go to the trauma center? If your FAST was negative, where would you start your US? Would you even consider doing US? In other words, the US probably would not change your destination. The US may not even be brought out in all cases just like the long board and C-collar is being disputed for all MVCs.

[jmp6753]

Im all about being progressive and forward thinking. That being said, at what point do we draw the line? Another piece of equipment for the ambulance (where space is already at premium). I am sure it will require some sort of certification and on-going training. I am sure that at some point during my career US will show up on my ambulance. Im just not ready to embrace the idea yet.

[VentMedic]

I do not feel that the way it would be used in EMS would require us to become RUT's. We would only be using it for a preliminary fast view.

I guess I lead you into assuming their acronym was "RUT".

I do love to introduce EMS professionals to other professions especially those that are younger than EMS and have some standards in their industry. Since US is made of several different specialities, it takes a bit of training and education to become good at more than one body area. Although the Paramedic will only be looking for that big bleed or air space, not every patient is going to be the typical 75 kg nicely structured non-complex patient that is an easy US. Missing something and having a false sense of security thus changing your transport destination away from the trauma center can also have its consequences.

Physicians do US at bedside in the ED, ICU and OR everyday but even as MDs they had to spend some time with another professional to perfect their technique and interpretations.

The American Registry for Diagnostic Medical Sonography (1975)

http://www.ardms.org/downloads/Prerequisite_Chart.pdf

http://www.ardms.org/default.asp?ContentID=1&menubar=1

http://www.ardms.org/default.asp?ContentID=30&menubar=3

Credentials

RDMS – Registered Diagnostic Medical Sonographer

RDCS - Registered Diagnostic Cardiac Sonographer

RVT - Registered Vascular Technologist

RPVI - Registered Physician Vascular Interpretation

Examinations

Abdomen

Adult Echocardiography

Breast

Cardiovascular Principles & Instrumentation Physics

Fetal Echocardiography

Neurosonology

Obstetrics and Gynecology

Pediatric Echocardiography

Ultrasound Physics & Instrumentation

Vascular Physical Principles & Instrumentation

Vascular Technology

Physicians' Vascular Interpretation

Sonography Principles & Instrumentation

[Don1977]

We are medivcs and EMTs not OB doctors...are you kidding?