Division of Emergency Medicine, Department of Medicine, Western University, London, ON.
ORNGE, Mississauga, ON.
CJEM. 2020 Sep;22(S2):S74-S78. doi: 10.1017/cem.2020.29.
Point of care ultrasound (POCUS) is an essential tool for physicians to guide treatment decisions in both hospital and prehospital settings. Despite the potential patient care and system utilization benefits of prehospital ultrasound, the financial burden of a "hands-on" training program for large numbers of paramedics remains a barrier to implementation. In this study, we conducted a prospective, observational, double-blinded study comparing paramedics to emergency physicians in their ability to generate usable abdominal ultrasound images after a 1-hour didactic training session.
Canadian aeromedical critical care paramedics were compared against emergency medicine physicians in their ability to generate adequate abdominal ultrasound images on five healthy volunteers. Quality of each scan was evaluated by a trained expert in POCUS who was blinded to the identity of the participant using a 5-point Likert scale and using the standardized QUICk Focused Assessment with Sonography in Trauma (FAST) assessment tool.
Fourteen Critical care paramedics and four emergency department (ED) physicians were voluntarily recruited. Of paramedics, 57% had never used ultrasound before, 36% has used ultrasound without formal training, and 7% had previous training. Physicians had a higher proportion of usable scans compared with paramedics (100% v. 61.4%, Δ38.6%; 95% confidence interval, 19.3-50.28).
Paramedics were not able to produce images of interpretable quality at the same frequency when compared with emergency medicine physicians. However, a 61.4% usable image rate for paramedics following a short 1-hour didactic training session is promising for future studies, which could incorporate a short hands-on tutorial while remaining cost-effective.
床边超声（POCUS）是医生在医院和院前环境中指导治疗决策的重要工具。尽管院前超声具有潜在的患者护理和系统利用效益，但为大量护理人员实施“动手”培训计划的财务负担仍然是实施的障碍。在这项研究中，我们进行了一项前瞻性、观察性、双盲研究，比较了护理人员和急诊医师在经过 1 小时的理论培训后生成可用腹部超声图像的能力。
将加拿大航空医疗急救护理人员与急诊医师进行比较，以评估他们在 5 名健康志愿者上生成足够的腹部超声图像的能力。由一名经过 POCUS 培训的专家使用 5 分李克特量表和标准化 QUICk 焦点评估超声创伤（FAST）评估工具对每个扫描的质量进行评估，该专家对参与者的身份一无所知。
自愿招募了 14 名急救护理人员和 4 名急诊医生。在护理人员中，57%的人以前从未使用过超声，36%的人未经正规培训使用过超声，7%的人接受过培训。与护理人员相比，医生的可用扫描比例更高（100%比 61.4%，差异为 38.6%；95%置信区间为 19.3-50.28）。
与急诊医师相比，护理人员无法以相同的频率生成可解释质量的图像。然而，在经过 1 小时的短理论培训后，护理人员的可用图像率为 61.4%，这为未来的研究提供了希望，未来的研究可以在保持成本效益的同时，纳入短期实践教程。
