Ultrasound response.

I will try and answer questions that have been asked.

First off the equipment we have used is the sonosite 180. We have been doing US in the field for 1 year and 7 months now. We recently switched to the sonosite I-Look. We are looking at hard mounting this equipment in our aircraft. You are able to save images on both devices for QI purposes however with the I-Look you can't hook up a digital recorder as of yet. This is also helpful in QI and we used it for one of our studies.

The flight nurses and flight medics are doing the actual procedure. All of our staff fly full time helicopter. Both the medics and the nurses are interpreting the data. Images are saved to the "hard drive" and later QI'd by our Medical Director. Paperwork is filled out on all patients so the MD's are able to follow up.

Our first study looked at training. The study was presented in Sweden and also presented at AAMS (I was suppose to be there but my father died of cancer the same week). This study has been submitted for publication and frankly I can't remember right now which periodical(s) it was sent in to.

Our training consisted of 4 hours of lecture, 3 hours of hands on training on each other the 3 physicians and 1 sonosite rep and then roughly an hour was spent on looking at images, both positive and negative and identifying structures etc. We then spent 8 hours in a busy level one trauma center ED (One of the first to use US in the ED) and literally performed US on almost all patients we could. Staff physicians assisted as needed and confirmed our readings. We then took a written test and competency exam given by medical director. This was then repeated in a year (the testing).

In a nut shell we found that the training was adequate. Our correct reads were high with a rate at about 93%. WE did find however that we rarely got a full FAST exam. Typically the apical view, morrisons pouch were completed , then the pelvic view and then splenorenal views. In part this was due to or ship configuration, and time limits. We do most of our procedures in flight so many times, IV's meds and intubations are getting done first.

We are now looking at diagnosis shock states from the US.

The big questions does it affect patient care in our environment. I do agree with Mr.Bulkley's sentiments. We have debated different triage approaches based on our US findings. In particular I have found it very helpful in OB (Monitoring FHT's and Movement), It is extremely helpful in diagnosis a true PEA. It has been interesting when I have thought to felt a pulse (Lots of vibrations and motion in the aircraft) and then will do an US and the patient will be in a true PEA. Hypothermia and PEA versus cardiac motion has been helpful also. It has also been nice to be able to look at the Aorta and differentiate if there is a TAA, AAA, then the treatment algorithms change for blood pressure control and beta blockade etc.