Prehospital Evaluation of Effusion, Pneumothorax, & Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services

• Published in: The western journal of emergency medicine Vol. 16; no. 4; pp. 503 - 509
• Main Authors: Bhat, Sundeep, Johnson, David, Pierog, Jessica, Zaia, Brita, Williams, Sarah, Gharahbaghian, Laleh
• Format: Journal Article
• Language: English
• Published: United States Department of Emergency Medicine, University of California, Irvine School of Medicine 01.07.2015
• Subjects: Adult; California; Emergency Medical Services; Emergency Medical Technicians - education; Female; Heart Arrest - diagnostic imaging; Humans; Male; Pericardial Effusion - diagnostic imaging; Pneumothorax - diagnostic imaging; Point-of-Care Testing - utilization; Prehospital Care; Prospective Studies; Ultrasonography; Young Adult
• ISSN: 1936-900X; 1936-9018
• DOI: 10.5811/westjem.2015.5.25414

In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images. We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties. Participants completed a pre-test of sonographic imaging of normal findings and three pathologic findings: pericardial effusion, pneumothorax, and cardiac standstill. A focused one-hour lecture on emergency US imaging followed. Post-tests were given to all EMS providers immediately following the lecture and to a subgroup one week later. We enrolled 57 prehospital providers (19 EMT-B students, 16 EMT-P students, 18 certified EMT-B, and 4 certified EMT-P). The mean pre-test score was 65.2%±12.7% with mean immediate post-test score of 91.1%±7.9% (95% CI [22%-30%], p<0.001). Scores significantly improved for all three pathologic findings. Nineteen subjects took the one-week post-test. Their mean score remained significantly higher: pre-test 65.8%±10.7%; immediate post-test 90.5%±7.0% (95% CI [19%-31%], p<0.001), one-week post-test 93.1%±8.3% (95% CI [21%-34%], p<0.001). Using a small sample of EMS providers and students, this study shows the potential feasibility for educating prehospital providers to accurately identify images of pericardial effusion, pneumothorax, and cardiac standstill after a focused lecture.