University of Calgary MD program, #108 1990 West 6 Avenue, Vancouver, BC V6J 4V4, Canada.
BMC Emerg Med. 2014 Mar 1;14:6. doi: 10.1186/1471-227X-14-6.
Advances in ultrasound imaging technology have made it more accessible to prehospital providers. Little is known about how ultrasound is being used in the prehospital environment and we suspect that it is not widely used in North America at this time. We believe that EMS system characteristics such as provider training, system size, population served, and type of transport will be associated with use or non-use of ultrasound. Our study objective was to describe the current use of prehospital ultrasound in North America.
This study was a cross-sectional survey distributed to EMS directors on the National Association of EMS Physicians (NAEMSP) mailing list. Respondents had the option to complete a paper or electronic survey.
Of the 755 deliverable surveys we received 255 responses from across Canada and the United states for an overall response rate of 30%. Of respondents, 4.1% of EMS systems (95% CI 1.9, 6.3) reported currently using ultrasound and an additional 21.7% (95% CI 17, 26.4) are considering implementing ultrasound. EMS services using ultrasound have a higher proportion of physicians (p < 0.001) as their highest trained prehospital providers when compared to the survey group as a whole. The most commonly cited current and projected applications are Focused Abdominal Sonography for Trauma (FAST) and assessment of pulseless electrical activity (PEA) arrest. The cost of equipment and training are the most significant barriers to implementation of ultrasound. Most medical directors want evidence that prehospital ultrasound improves patient outcomes prior to implementation.
Prehospital ultrasound is infrequently used in North America and there are a number of barriers to its implementation, including costs of equipment and training and limited evidence demonstrating improved outcomes. A research agenda for prehospital ultrasound should focus on patient-important outcomes such as morbidity and mortality. Two commonly used indications that could be a focus of standardized training programs are the FAST exam, and assessment of PEA arrest.
超声成像技术的进步使得院前提供者更容易获得。目前还不太清楚超声在院前环境中是如何使用的，我们怀疑此时它在北美的应用并不广泛。我们认为，EMS 系统的特点，如提供者培训、系统规模、服务人群和运输类型，将与超声的使用或不使用相关。我们的研究目的是描述北美目前院前使用超声的情况。
本研究是一项横断面调查，通过国家急诊医师协会（NAEMSP）的邮寄名单分发给 EMS 主任。回答者可以选择填写纸质或电子调查问卷。
在我们收到的 755 份可交付的调查中，来自加拿大和美国各地的有 255 份回复，总体回复率为 30%。在回答者中，4.1%（95%置信区间为 1.9%，6.3%）的 EMS 系统报告目前正在使用超声，另有 21.7%（95%置信区间为 17%，26.4%）正在考虑实施超声。与整个调查小组相比，使用超声的 EMS 服务中，具有更高比例的医生（p<0.001）作为其最高培训的院前提供者。目前和预计的最常见应用是创伤焦点腹部超声（FAST）和无脉电活动（PEA）骤停评估。设备和培训的成本是实施超声的最大障碍。大多数医疗主任希望在实施前有证据表明院前超声能改善患者的预后。
在北美，院前超声的使用频率较低，且存在一些实施障碍，包括设备和培训的成本以及有限的证据表明可以改善结果。院前超声的研究议程应侧重于对患者重要的结果，如发病率和死亡率。两个常用的可能是标准化培训计划重点的适应症是 FAST 检查和 PEA 骤停评估。
