Advanced Techniques in Prehospital Ultrasound (Real-World Application of Prehospital POCUS and Effects on Patient Care)

Summary: The role of Point-of-Care Ultrasound (POCUS) continues to expand in the prehospital environment, with more services adopting this technology to facilitate earlier diagnosis and treatment. While this technology has been used in Helicopter EMS for over a decade, it has only recently entered the ground EMS arena. In the United States, fewer than 10% of EMS agencies have POCUS programs, with most use in air EMS services. As portability, durability, and cost have improved, it has allowed this technology to be utilized in several life-saving areas. This, coupled with the increasing literature base demonstrating the ability of paramedics to perform POCUS with accurate interpretation, has opened the possibility of its use in this space. Significant applications in the prehospital environment include identifying life-threatening traumatic injuries such as pneumothorax, cardiac tamponade, and abdominal bleeding, as well as differentiating heart failure from COPD in critically ill patients with respiratory distress. Furthermore, POCUS can be used in early assessment of ROSC in cardiac arrest, as well as determining hemodynamics and volume status to guide resuscitation. This case series will focus on various clinical scenarios from a large urban ground EMS service that has adopted POCUS in its agency. The case series will include differentiating causes of dyspnea, identification of traumatic injuries, and its use during cardiac arrest management. We will highlight how POCUS was utilized in this setting and how care was changed based on the POCUS findings.