First responders have stayed away from diagnosing patients. We were taught that isn’t our job. We should complete our assessments, package the patient, transport and give a succinct pass on to the accepting nurse.
The times they are a changin’.
Today’s first responders, specifically paramedics, find themselves in the proverbial driver’s seat regarding early medical diagnosis—or really, the ability to formulate a differential diagnosis successfully. What changed? For one, the tools and technology that are at our disposal.
Targeted implementation
In the early 2000s, 12-lead electrocardiograms and capnography weren’t used in the field. The latter now is considered as commonplace as taking a blood pressure.
What’s the next big thing for prehospital care?
For South Metro Fire Rescue (SMFR) in Centennial, CO, it’s POCUS, or point-of-care ultrasound.
Capt. Jodi Peterson of SMFR’s EMS Clinical Services would argue that POCUS in the field isn’t progressive, even though her department might be one of the very few that uses it. Instead, Peterson says SMFR is thoughtful and targeted in its implementation of ultrasound.
Of course, many of us are somewhat familiar with ultrasound. However, I was curious about it in the prehospital setting. How does it improve patient outcome? On what type of calls is ultrasound is used? What’s the cost?
Explaining the improvements
Peterson says that in the early inception of POCUS, the device initially was used on medical cardiac arrests to detect pulses and termination of resuscitation (TOR). Nearly five years after its adoption, ultrasound is used to detect COVID-19 pneumonia and trauma, with a goal to decrease time to blood products.
As with most changes in the fire service, Peterson says the boots on the ground weren’t in overwhelming agreement on the adoption of POCUS. One common question that emerged among some of the seasoned first responders was, “If what I’m doing works, and I’m successful with my treatments, why do I have to change?”
“It was a long, slow, uphill climb,” Peterson explains. “Culturally, it’s really different asking EMS providers to do imaging, which might be out of their bandwidth.”
Providers had to be convinced that ultrasound could improve the course of care and improve time to treatment.
Increased confidence
Additionally, the psychological benefit of being able to differentially diagnose a patient in the field was something no one had considered.
In an SMFR document that Peterson shared with us, she wrote, “EMS professionals encounter extreme patient criticality in the setting of situational, psychological and emotional chaos. Having POCUS imaging at the point of care helped with informed TOR decisions, critical care interventions and disposition decisions, all leading to increased paramedic confidence, which influences improved mental health and well-being.”
Manageable cost
The cost of such devices in the field is less expensive than one might believe, Peterson offers.
SMFR procured POCUS devices through the Butterfly Network. Doing a cursory search of the Butterfly Network’s website, an EMS provider could spend between $2,700–$4,500 for an ultrasound device.
Peterson says ultrasound probes are paired with a Butterfly iQ app, to display real-time images. This allows for paramedic interpretation/documentation and uploads for analysis and storage in a HIPAA-compliant cloud.
For the right reasons
At the end of the day, implementation of POCUS takes time, research and building relationships, Peterson says.
She adds that a decision to implement POCUS at a department because it’s “the next best thing” sets up a program for failure. “You have to have medical direction and a training bureau that helps you train with this.”
