Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service
Abstract Background There has been increased use of prehospital point-of-care ultrasound (PoCUS) by helicopter emergency medical services (HEMS) in recent years. Lack of governance structure and evidence of benefit have been described as major barriers to its implementation. This paper describes a n...
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| Format: | Article |
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BMC
2025-02-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01340-3 |
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| author | Salman Naeem Shadman Aziz Thomas Hirst Johannes Strobel Jamin M. Mulvey Ailidh Lang Jankee Patel Alexander Smith Ka Jun Cheng Michael Palmer Jonas Schlautmann Michael D. Christian Daniel Nevin |
| author_facet | Salman Naeem Shadman Aziz Thomas Hirst Johannes Strobel Jamin M. Mulvey Ailidh Lang Jankee Patel Alexander Smith Ka Jun Cheng Michael Palmer Jonas Schlautmann Michael D. Christian Daniel Nevin |
| author_sort | Salman Naeem |
| collection | DOAJ |
| description | Abstract Background There has been increased use of prehospital point-of-care ultrasound (PoCUS) by helicopter emergency medical services (HEMS) in recent years. Lack of governance structure and evidence of benefit have been described as major barriers to its implementation. This paper describes a novel approach to implementation of prehospital PoCUS and clinical governance framework in a UK HEMS. Methods A retrospective database review was undertaken at London’s Air Ambulance (LAA) from 1st September 2021 to 31st March 2023. All patients who had PoCUS examination were included. Scans were archived in a cloud-based server and reviewed weekly by expert clinicians. They were graded in adequacy, agreement between reviewer and clinician was recorded and fed back to the clinicians allowing continuous feedback learning. In-hospital diagnosis was sought for patients having the full Pump, Pleura and Pouring blood (PPPB) protocol. Cohen’s Kappa (ƙ) was calculated for inter-rater reliability. Sensitivity and specificity analysis was performed using 2 × 2 tables. Results LAA attended 3,068 missions. Our reviewers identified 701 PoCUS scanning encounters and 628 were included in the final analysis. Clinicians performed 420 scans for pneumothorax, 308 for free fluid and 305 pericardial effusions respectively. Majority of the population were male (85%) who sustained traumatic (93.5%) thoracic injuries (65%). Paramedics performed 29% of the scans. Reviewers deemed 83% of the scans of adequate quality. Inter-rater reliability between clinicians and reviewers was 0.6 for pericardial effusion, 0.67 for pneumothorax and 0.71 for free fluid respectively. A full PPPB protocol was performed in 52 patients out of which 46 were included. The sensitivity and specificity of PPPB protocol for diagnosis life-threatening injuries was 0.5 and 0.9 respectively. Conclusion Introduction of prehospital PoCUS in a HEM service utilizing high quality training, user-friendly workflow and image archiving system, robust governance framework and continuous feedback may be feasible allowing high quality ultrasound examinations. The bespoke PPPB protocol in prehospital may improve diagnosis of life-threatening injuries. |
| format | Article |
| id | doaj-art-5a61cc78181c4f74907f84e8e0e0db4f |
| institution | Kabale University |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-5a61cc78181c4f74907f84e8e0e0db4f2025-02-09T12:52:13ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-02-013311910.1186/s13049-025-01340-3Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical serviceSalman Naeem0Shadman Aziz1Thomas Hirst2Johannes Strobel3Jamin M. Mulvey4Ailidh Lang5Jankee Patel6Alexander Smith7Ka Jun Cheng8Michael Palmer9Jonas Schlautmann10Michael D. Christian11Daniel Nevin12London’s Air Ambulance Charity, Royal London HospitalDepartment of Research, Audit, Innovation, and Development, East Anglian Air AmbulanceDepartment of Anaesthesia, Royal Free HospitalLondon’s Air Ambulance Charity, Royal London HospitalDepartment of Anaesthesiology, Queensland Children’s HospitalDepartment of Emergency Medicine, University College London Hospitals NHS Foundation TrustDepartment of Emergency Medicine, London North West University Healthcare NHS TrustDepartment of Critical Care, Guy’s and St Thomas’ NHS Foundation TrustDepartment of Emergency Medicine, Maidstone and Tunbridge Wells NHS TrustLondon Ambulance Service NHS TrustDepartment of Acute Medicine, University Hospital SussexLondon’s Air Ambulance Charity, Royal London HospitalLondon’s Air Ambulance Charity, Royal London HospitalAbstract Background There has been increased use of prehospital point-of-care ultrasound (PoCUS) by helicopter emergency medical services (HEMS) in recent years. Lack of governance structure and evidence of benefit have been described as major barriers to its implementation. This paper describes a novel approach to implementation of prehospital PoCUS and clinical governance framework in a UK HEMS. Methods A retrospective database review was undertaken at London’s Air Ambulance (LAA) from 1st September 2021 to 31st March 2023. All patients who had PoCUS examination were included. Scans were archived in a cloud-based server and reviewed weekly by expert clinicians. They were graded in adequacy, agreement between reviewer and clinician was recorded and fed back to the clinicians allowing continuous feedback learning. In-hospital diagnosis was sought for patients having the full Pump, Pleura and Pouring blood (PPPB) protocol. Cohen’s Kappa (ƙ) was calculated for inter-rater reliability. Sensitivity and specificity analysis was performed using 2 × 2 tables. Results LAA attended 3,068 missions. Our reviewers identified 701 PoCUS scanning encounters and 628 were included in the final analysis. Clinicians performed 420 scans for pneumothorax, 308 for free fluid and 305 pericardial effusions respectively. Majority of the population were male (85%) who sustained traumatic (93.5%) thoracic injuries (65%). Paramedics performed 29% of the scans. Reviewers deemed 83% of the scans of adequate quality. Inter-rater reliability between clinicians and reviewers was 0.6 for pericardial effusion, 0.67 for pneumothorax and 0.71 for free fluid respectively. A full PPPB protocol was performed in 52 patients out of which 46 were included. The sensitivity and specificity of PPPB protocol for diagnosis life-threatening injuries was 0.5 and 0.9 respectively. Conclusion Introduction of prehospital PoCUS in a HEM service utilizing high quality training, user-friendly workflow and image archiving system, robust governance framework and continuous feedback may be feasible allowing high quality ultrasound examinations. The bespoke PPPB protocol in prehospital may improve diagnosis of life-threatening injuries.https://doi.org/10.1186/s13049-025-01340-3PoCUSPrehospitalHEMSTraumaPneumothoraxPericardial effusion |
| spellingShingle | Salman Naeem Shadman Aziz Thomas Hirst Johannes Strobel Jamin M. Mulvey Ailidh Lang Jankee Patel Alexander Smith Ka Jun Cheng Michael Palmer Jonas Schlautmann Michael D. Christian Daniel Nevin Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine PoCUS Prehospital HEMS Trauma Pneumothorax Pericardial effusion |
| title | Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service |
| title_full | Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service |
| title_fullStr | Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service |
| title_full_unstemmed | Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service |
| title_short | Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service |
| title_sort | implementation of prehospital point of care ultrasound using a novel continuous feedback approach in a uk helicopter emergency medical service |
| topic | PoCUS Prehospital HEMS Trauma Pneumothorax Pericardial effusion |
| url | https://doi.org/10.1186/s13049-025-01340-3 |
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