Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK.
Emergency and Critical Care Departments, North West Anglia Foundation Trust, Peterborough, UK.
Scand J Trauma Resusc Emerg Med. 2024 Jun 3;32(1):49. doi: 10.1186/s13049-024-01224-y.
There has been a rapid expansion in the use of point-of-care ultrasonography (POCUS) by emergency medical services (EMS). However, less than a third of UK EMS utilise imaging archiving for POCUS, and fewer review saved images as part of a clinical governance structure. This paper describes the implementation of a novel image archiving system and a robust clinical governance framework in our UK physician-paramedic staffed helicopter emergency medical service (HEMS).
A retrospective database review was conducted of all patients attended by East Anglian Air Ambulance (EAAA) between the introduction of a new POCUS device and image archiving system on 1 December 2020 to 31 January 2024. All patients with recorded POCUS examinations were included. Images from POCUS examinations at EAAA are archived on a cloud-based server, and retrospectively reviewed within 24 h by an EAAA POCUS supervisor. Image quality is graded using a 5-point Likert-type scale, agreement between reviewer and clinician is recorded and feedback is provided on scanning technique. T-tests were used to assess the difference in image quality between physicians and paramedics. Inter-rater reliability between reviewers and clinicians was assessed using Cohen's kappa (κ).
During the study period, 5913 patients were attended by EAAA. Of these, 1097 patients had POCUS images recorded. The prevalence of POCUS during the study period was 18.6%. 1061 patient examinations underwent quality assurance (96.7%). The most common POCUS examination was echocardiography (60%), predominantly during cardiac arrest. The primary scanning clinician was a paramedic in 25.4% of POCUS examinations. Across all examination types; image quality was not significantly different between physicians and paramedics and agreement between reviewers and clinicians was strong (κ > 0.85).
In this service evaluation study, we have described outcomes following the introduction of a new POCUS device, image archiving system and governance framework in our HEMS. Paramedics were the primary scanning clinician in a quarter of scans, with image quality comparable to physicians. Almost all scans underwent quality assurance and inter-rater reliability was strong between clinicians and reviewers. Further research is required to investigate the diagnostic accuracy of POCUS and to demonstrate the effect of utilising prehospital POCUS to refine diagnosis on clinical outcomes.
紧急医疗服务（EMS）中使用即时超声检查（POCUS）的情况迅速扩大。然而，英国只有不到三分之一的 EMS 使用 POCUS 成像存档，并且更少的审查将保存的图像作为临床治理结构的一部分。本文描述了在我们的英国医师-护理员人员配备的直升机紧急医疗服务（HEMS）中，新型成像存档系统和强大的临床治理框架的实施情况。
对 2020 年 12 月 1 日至 2024 年 1 月 31 日期间引入新的 POCUS 设备和图像存档系统以来，东盎格鲁空中救护（EAAA）治疗的所有患者的回顾性数据库进行了审查。所有记录有 POCUS 检查的患者均包括在内。EAAA 上的 POCUS 检查的图像存储在基于云的服务器上，并由 EAAA 的 POCUS 主管在 24 小时内进行回顾性审查。使用 5 分李克特量表对图像质量进行分级，记录审查员和临床医生之间的一致性，并提供扫描技术的反馈。使用 t 检验评估医师和护理员之间图像质量的差异。使用 Cohen's kappa（κ）评估审查员和临床医生之间的评分者间可靠性。
在研究期间，EAAA 共治疗了 5913 名患者。其中，有 1097 名患者的 POCUS 图像被记录。研究期间 POCUS 的流行率为 18.6%。1061 例患者的检查接受了质量保证（96.7%）。最常见的 POCUS 检查是超声心动图（60%），主要在心脏骤停期间进行。在所有 POCUS 检查中，初级扫描临床医生是护理员的占 25.4%。在所有检查类型中；医师和护理员之间的图像质量没有显著差异，审查员和临床医生之间的一致性很强（κ＞0.85）。
在这项服务评估研究中，我们描述了在我们的 HEMS 中引入新的 POCUS 设备、图像存档系统和治理框架后的结果。在四分之一的扫描中，护理员是主要的扫描临床医生，其图像质量与医师相当。几乎所有的扫描都经过了质量保证，临床医生和审查员之间的评分者间可靠性很强。需要进一步研究以调查 POCUS 的诊断准确性，并证明利用院前 POCUS 改善诊断对临床结果的影响。
