Preview

Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations

Advanced search

Diagnostic ultrasound examinations during evacuation of urgent patients by ambulance helicopters: literature review

https://doi.org/10.25016/2541-7487-2022-0-2-42-51

Abstract

Relevance. The use of ultrasound diagnostics at the place of providing medical care to an urgent patient is one of the promising directions in the development of emergency medicine. At the same time, of particular interest is the possibility of using diagnostic ultrasound in an ambulance helicopter, given the lack of clear algorithms and standards for its application, as well as the limited number of publications on this problem.
Intention. Analysis of publications on the use of urgent ultrasound examination in an ambulance helicopter.
Methodology. A search was made for scientific publications on the topic on the electronic resource PubMed, in the Google Scholar search system for the period from 2000 to 2021.
Results and discussion. The main algorithms used for ultrasound diagnostics of an urgent patient in an ambulance helicopter are Focused Assessment with Sonography for Trauma (FAST), point-of-care ultrasound (POCUS), Rapid Ultrasound in SHock (RUSH), Bedside Lung Ultrasound in Emergency (BLUЕ), prehospital ultrasonography (PHUS), etc. They help exclude damage to vital organs and emergency pathology – pneumo- and hemothorax, hemoperitoneum, hemopericardium, large fractures and others that affect the tactics of treatment and patient routing; there is also the possibility of ultrasound navigation for a number of medical and diagnostic procedures. According to the results of published studies and clinical observations, prehospital ultrasound examination of urgent patients is successfully used during medical evacuation by an ambulance helicopter in emergency medical services in many countries of the world (both by doctors and other medical personnel), making it possible to diagnose a number of lifethreatening conditions with a fairly high accuracy, without loss of time and without damage to patient’s health. An important aspect of the successful application of the method during flight is the training of qualified personnel. The prospects for the development of the method are the development of more advanced ultrasound scanners and sensors adapted to flight conditions, as well as the use of telemedicine technologies for remote analysis of ultrasound images.
Conclusion. The experience of using prehospital diagnostic ultrasound in an ambulance helicopter requires further data accumulation and systematic analysis, but the method is already undoubtedly useful in determining the tactics of treatment and the route of hospitalization of urgent patients with acute trauma and a number of other pathological conditions.

About the Authors

S. A. Gumenyuk
Moscow Territorial Scientific and Practical Center for Disaster Medicine of the Moscow City Health Department
Russian Federation

Sergey Andreevich Gumenyuk – PhD. Med. Sci., Director

5, pr. 1, B. Sukharevskaya sq., Moscow, 12909 



S. S. Aleksanin
The Nikiforov Russian Center of Emergency and Radiation Medicine. EMERCOM of Russia
Russian Federation

Sergei Sergeevich Aleksanin – Dr. Med. Sci. Prof., Corresponding Member of Russian Academy of Sciences, Director

4/2, Academica Lebedeva Str., St. Petersburg, 194044 



A. M. Schikota
Moscow Territorial Scientific and Practical Center for Disaster Medicine of the Moscow City Health Department; Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine
Russian Federation

Aleksey Mikhailovich Shikota – PhD. Med. Sci. Senior Research Associate;
scientific secretary 

5, pr. 1, B. Sukharevskaya sq., Moscow, 12909 

53, Zemlyanoy Val Str., Moscow, 105120 



V. I. Yarema
Moscow Territorial Scientific and Practical Center for Disaster Medicine of the Moscow City Health Department
Russian Federation

Vladimir Ivanovich Yarema – Dr. Med. Sci. Prof., Leading Research Associate

5, pr. 1, B. Sukharevskaya sq., Moscow, 12909 



I. V. Pogonchenkova
Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine
Russian Federation

Irena Vladimirovna Pogonchenkova – Dr. Med. Sci., Director

53, Zemlyanoy Val Str., Moscow, 105120 



References

1. Alstrup K., Møller T.P., Knudsen L. [et al.]. Characteristics of patients treated by the Danish Helicopter Emergency Medical Service from 2014-2018: a nationwide population-based study. Scand. J. Trauma Resusc. Emerg. Med. 2019; 27(1):102. DOI: 10.1186/s13049-019-0672-9.

2. Amaral CB., Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Medicine. 2020; 8:2050312120932706. DOI: 10.1177/2050312120932706.

3. Biegler N., McBeth P.B., Tiruta C. [et al.]. The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance‘a remote virtual mentor. Crit. Ultrasound J. 2013; 5(1):5. DOI: 10.1186/2036-7902-5-5.

4. Bloom B.A., Gibbons R.C. Focused Assessment with Sonography for Trauma. 2020. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing. PMID: 29261902.

5. Brooke M., Walton J., Scutt D. Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature. Emerg. Med. J. 2010; 27(9):702–707. DOI: 10.1136/emj.2010.094219.

6. Brun P.M., Bessereau J., Chenaitia H. [et al.]. Stay and play eFAST or scoop and run eFAST? That is the question! Am. J. Emerg. Med. 2014; 32(2):166–170. DOI: 10.1016/j.ajem.2013.11.008.

7. Brun P.M., Chenaitia H., Lablanche C. [et al.]. 2-point ultrasonography to confirm correct position of the gastric tube in prehospital setting. Mil. Med. 2014; 179(9):959–963. DOI: 10.7205/MILMED-D-14-00044.

8. Chan K.K., Joo D.A., McRae A.D. [et al.]. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst. Rev. 2020; 7(7):CD013031. DOI: 10.1002/14651858.CD013031.pub2.

9. Darocha T., Gałązkowski R., Sobczyk D. [et al.]. Point-of-care ultrasonography during rescue operations on board a Polish Medical Air Rescue helicopter. J. Ultrason. 2014; (59):414-420. DOI: 10.15557/jou.2014.0043.

10. Farsi D., Hajsadeghi S., Hajighanbari M.J. [et al.]. Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular disease. J. Ultrasound. 2017; 20(2):133–138. DOI: 10.1007/s40477-017-0246-5.

11. Fevang E., Lockey D., Thompson J. [et al.]. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration. Scand. Trauma Resusc. Emerg. Med. 2011; 19:57. DOI: 10.1186/1757-7241-19-57.

12. Gracias V.H., Frankel H.L., Gupta R. [et al.]. Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing. Am. Surg. 2001; 67(4):364–368.

13. Hanley P., Holden J., Johnson T. [et al.]. Two cases of penetrating left ventricular cardiac trauma: Pre-hospital ultrasound and direct to theatre. Trauma Case Reports. 2019; 21:100189. DOI: 10.1016/j.tcr.2019.100189.

14. Harjola P., Miró Ò., Martín-Sánchez F.J. [et al.]. EMS-AHF Study Group. Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure. ESC Heart Fail. 2020; 7(1):289–296. DOI: 10.1002/ehf2.12524.

15. Heegaard W., Hildebrandt D., Spear D. [ et al.]. Prehospital ultrasound by paramedics: results of field trial. Acad. Emerg. Med. 2010; 17(6):624–630. DOI: 10.1111/j.1553-2712.2010.00755.x.

16. Hilbert-Carius P., Struck M.F., Rudolph M. [et al.]. POCUS in HEMS collaborators. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand. J. Trauma Resusc. Emerg. Med. 2021; 29(1):124. DOI: 10.1186/s13049-021-00933-y.

17. Hoyer H.X., Vogl S., Schiemann U. [et al.]. Prehospital ultrasound in emergency medicine: incidence, feasibility, indications and diagnoses. Eur. J. Emerg. Med. 2010; 17(5):254–259. DOI: 10.1097/MEJ.0b013e328336ae9e.

18. Jorgensen H., Jensen C.H., Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur. J. Emerg. Med. 2010; 17(5):249–253. DOI: 10.1097/MEJ.0b013e328336adce.

19. Hussain A., Via G., Melniker L. [et al.]. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus. Crit. Care. 2020; 24(1):702. DOI: 10.1186/s13054-020-03369-5.

20. Ketelaars R., Reijnders G., van Geffen G.J. [et al.]. ABCDE of prehospital ultrasonography: a narrative review. Critical Ultrasound Journal. 2018; 10(1):17. DOI: 10.1186/s13089-018-0099-y.

21. Ketelaars R., Holtslag J.J.M., Hoogerwerf N. Abdominal prehospital ultrasound impacts treatment decisions in a Dutch Helicopter Emergency Medical Service. Eur. J. Emerg. Med. 2019; 26(4):277–282. DOI: 10.1097/MEJ.0000000000000540.

22. Ketelaars R., Beekers C., Van Geffen G.J. [et al.]. Prehospital Echocardiography During Resuscitation Impacts Treatment in a Physician-Staffed Helicopter Emergency Medical Service: an Observational S23.tudy. Prehosp. Emerg. Care. 2018; 22(4):406–413. DOI: 10.1080/10903127.2017.1416208.

23. Kirkpatrick A.W., McKee I., McKee J.L. [et al]. Remote just-in-time telementored trauma ultrasound: a double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display. Am. J. Surg. 2016; 211(5):894–902. DOI: 10.1016/j.amjsurg.2016.01.018.

24. Krogh C.L., Steinmetz J., Rudolph S.S. [et al.]. Effect of ultrasound training of physicians working in the prehospital setting. Scand. J. Trauma Resusc. Emerg. Med. 2016; 24:99. DOI: 10.1186/s13049-016-0289-1.

25. Labovitz A.J., Noble V.E., Bierig M. [et al.]. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J. Am. Soc. Echocardiogr. 2010; 23(12):1225–1230. DOI: 10.1016/j.echo.2010.10.005.

26. Lenz T.J, Phelan M.B., Grawey T. Determining a Need for Point-of-Care Ultrasound in Helicopter Emergency Medical Services Transport. Air Med. J. 2021; 40(3):175–178. DOI: 10.1016/j.amj.2021.01.003.

27. Lichtenstein D.A., Mezière G.A. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008; 134(1):117–125. DOI: 10.1378/chest.07-2800

28. Lichtenstein D.A. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015; 147(6):1659–1670. DOI: 10.1378/chest.14-1313.

29. Lyon M., Walton P., Bhalla V., Shiver SA. Ultrasound detection of the sliding lung sign by prehospital critical care providers. Am J. Emerg. Med. 2012; 30(3):485–488. DOI: 10.1016/j.ajem.2011.01.009.

30. Madill J.J. In-flight thoracic ultrasound detection of pneumothorax in combat. J. Emerg Med. 2010; 39(2):194–197. DOI: 10.1016/j.jemermed.2009.08.026.

31. Maggiolini S., Gentile G., Farina A. [et al.]. Safety, efficacy, and complications of pericardiocentesis by real-time echo-monitored procedure. Am. J. Cardiol. 2016; 117(8):1369–1374. DOI: 10.1016/j.amj-card.2016.01.043.

32. Marsh-Feiley G., Eadie L., Wilson P. Paramedic and physician perspectives on the potential use of remotely supported prehospital ultrasound. Rural Remote Health. 2018; 18(3):4574. DOI: 10.22605/RRH4574.

33. Melanson S.W., McCarthy J., Stromski C.J. [et al.]. Aeromedical trauma sonography by flight crews with a miniature ultrasound unit. Prehosp. Emerg. Care. 2001; 5(4):399–402. DOI: 10.1080/10903120190939607.

34. Mierzwa A.P., Huang S.P., Nguyen K.T. [et al.[]. Wearable ultrasound array for point-of-care imaging and patient monitoring. Stud. Health Technol. Inform. 2016; 220:241–244.

35. O’Dochartaigh D., Douma M., Alexiu C. [et al.]. Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit// Prehosp. Disaster Med. 2017. Oct.32(5). P.536-540. DOI: 10.1017/S1049023X1700646X.

36. O’Dochartaigh D., Douma M., MacKenzie M. Five-year Retrospective Review of Physician and Non-physician Performed Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service. Prehosp Emerg Care. 2017; 21(1):24–31. DOI: 10.1080/10903127.2016.1204036.

37. Paziana K., Fields J.M., Rotte M. [et al.]. Soft tissue foreign body removal technique using portable ultrasonography. Wilderness Environ Med. 2012; 23(4):343–348. DOI: 10.1016/j.wem.2012.04.006.

38. Press G.M., Miller S.K., Hassan I.A. [et al.]. Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. J. Emerg. Med. 2014; 47(6):638–645. DOI: 10.1016/j.jemermed.2014.07.056.

39. Price D.D., Wilson S.R., Murphy T.G. Trauma ultrasound feasibility during helicopter transport. Air Med. J. 2000; 19(4):144–146. DOI: 10.1016/s1067-991x (00)90008-7.

40. Quick J.A., Uhlich R.M., Ahmad S. [et al.]. In-flight ultrasound identification of pneumothorax. Emerg. Radiol. 2016; 23(1):3–7. DOI: 10.1007/s10140-015-1348-z.

41. Roline C.E., Heegaard W.G., Moore J.C. [et al.]. Feasibility of bedside thoracic ultrasound in the helicopter emergency medical services setting. Air Med. J. 2013; 32(3):153–157. DOI: 10.1016/j.amj.2012.10.013.

42. Rubin M.N., Barrett K.M., Freeman W.D. [et al.]. Teleneurosonology: a novel application of transcranial and carotid ultrasound. J. Stroke Cerebrovasc. Dis. 2015; 24(3):562–565. DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.032.

43. Siddiqui N., Arzola C., Friedman Z., Guerina L., You-Ten KE. Ultrasound improves cricothyrotomy success in cadavers with poorly defined neck anatomy: a randomized control trial. Anesthesiology. 2015.123(5):1033–1041. DOI: 10.1097/ALN.0000000000000848.

44. Soni N.J., Franco R., Velez M.I. [et al.]. Ultrasound in the diagnosis and management of pleural effusions. J. Hosp. Med. 2015; 10(12);811–816. DOI: 10.1002/jhm.2434.

45. Stawicki S.P., Howard J.M., Pryor J.P. [et al.]. Portable ultrasonography in mass casualty incidents: The CAVEAT examination. World J. Orthop. 2010; 1(1):10–19. DOI: 10.5312/wjo.v1.i1.10.

46. Stengel D., Rademacher G., Ekkernkamp A. [et al.]. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst. Rev. 2015; 2015(9):CD004446. DOI: 10.1002/14651858.CD004446.pub4.

47. Sumann G., Moens D., Brink B. [et al.]. Multiple trauma management in mountain environments – a scoping review: Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel. Scand. Trauma Resus. Emerg. Med. 2020; 28(1):117. DOI: 10.1186/s13049-020-00790-1.

48. Wimalasena Y., Windsor J., Edsell M. Using ultrasound lung comets in the diagnosis of high altitude pulmonary edema: fact or fiction? Wilderness Environ Med. 2013; 24(2):159–164. DOI: 10.1016/j.wem.2012.10.005.

49. Yates J.G., Baylous D. Aeromedical Ultrasound: The Evaluation of Point-of-care Ultrasound During Helicopter Transport. Air Med. J. 2017; 36(3):110–115. DOI: 10.1016/j.amj.2017.02.001.

50. Zadel S., Strnad M., Prosen G., Mekis D. Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. Resuscitation. 2015; 87:1–6. DOI: 10.1016/j.resuscitation.2014. 11.006.


Review

For citations:


Gumenyuk S.A., Aleksanin S.S., Schikota A.M., Yarema V.I., Pogonchenkova I.V. Diagnostic ultrasound examinations during evacuation of urgent patients by ambulance helicopters: literature review. Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations. 2022;(2):42-51. (In Russ.) https://doi.org/10.25016/2541-7487-2022-0-2-42-51

Views: 378


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1995-4441 (Print)
ISSN 2541-7487 (Online)