Emergency ultrasound in the prehospital setting

Paramedic practice in the UK has seen some diverse and lengthy changes in the last ten years. The way that ambulance services are now involved in emergency care is very different, with more focus placed on the efficient and appropriate use of other primary and secondary care resources. The advent of closer and more formal working relationships between prehospital care physicians and paramedics will provide the opportunity to further develop the quality of care delivered by the doctor-paramedic team. It is now widely accepted that for the most seriously injured patients out of hospital, the application of physician-led skills such as prehospital anaesthesia contribute significantly to the process of the early management of trauma and improvement of outcome ( Van der Hoeven and De Koning, 1995 ). Similarly, the development of the team approach has meant that more goal–led therapies can be instituted in a timely fashion. The use of ultrasound in the prehospital environment is not new. While its role is not yet fully established ( Brooke et al. 2010 ), it is nevertheless finding its rightful place in the hands of both trained physicians and paramedics. The diversity of applications for paramedic–led ultrasound is also gaining momentum with high levels of sensitivity and specificity reported ( Heiner and McArthur, 2010 ; Tazarourte et al, 2010 ). This article addresses some of the issues regarding the use of ultrasound in prehospital care and describes some of the applications which are taught in the emergency and prehospital ultrasound course at the Imperial College, London.