E-FAST Ultrasound Training Curriculum for Prehospital Emergency Medical Service (EMS) Clinicians.

Audience and Type of Curriculum: Audience and type of curriculum: This hybrid, asynchronous curriculum is designed for prehospital clinician colleagues, including but not limited to emergency medical technicians (EMT), advanced EMTs (AEMT), EMT-paramedics (EMT-P), critical care EMT-Ps (CCEMTP), critical care transport nurses (CCTN), and certified flight registered nurses (CFRN) to learn and practice ultrasound fundamentals in the setting of a standardized extended focused assessment with sonography in trauma (E-FAST) exam. Length of Curriculum: Over a five-month curriculum, learners will perform a pre-test, review online module lectures, attend an ultrasound scanning workshop, and perform post-test examinations. Introduction: The extended-focused assessment with sonography in trauma (E-FAST) exam can identify intrathoracic and intraabdominal free fluid, as well as pneumothoraces. The E-FAST ultrasound exam has previously been taught to clinicians of various backgrounds in healthcare including emergency medical service (EMS). However, an open-access, systemized curriculum for teaching E-FAST exams to EMS clinicians has not been published. Educational Goals: By the end of these training activities, prehospital EMS learners will be able to demonstrate foundational ultrasound skills in scanning, interpretation, and artifact recognition by identifying pertinent organs and anatomically relevant structures for an E-FAST examination. Learners will differentiate between normal and pathologic E-FAST ultrasound images by identifying the presence of free fluid and lung sliding. Learners will also explain the clinical significance and application of detecting free fluid during an E-FAST scan. Educational Methods: The educational strategies used in this curriculum include a hybrid, asynchronous curriculum encompassing 2.5 hours of lectures derived from online learning modules and in-person review. In addition, learners will attend 2 hours of hands-on proctored ultrasound scanning practicing E-FAST examinations. Research Methods: An online 13-question pre-test was administered prior to the study. An online post-test and in-person scanning OSCEs were administered at least eight weeks after their scheduled workshop consisting of an online 13-question multiple-choice post-test, a confidence survey, and a hands-on E-FAST Objectively Structured Clinical Exam (OSCE) session. A non-parametric Wilcoxon signed-rank test was performed between each pre-test and post-test metric to examine the statistical differences of paired data. Results: Post-test scores demonstrated statistically significant improvement in both image interpretation exams and ultrasound self-efficacy from the pre-test. The mean pre-test and post-test scores were 55.46% (7.21 ± 1.99) and 84.23% (10.89 ± 1.59) correct out of 13 questions, respectively (p < 0.0001). Participants surveyed an increase in self-efficacy reflected by a Likert scale for ultrasound usage and image interpretation (p < 0.005). The average post-test OSCE E-FAST exam score was 37.89 ± 2.76 out of 42 points (90.21%). Discussion: This 4.5-hour hybrid asynchronous model demonstrates an effective curriculum for teaching E-FAST ultrasound to prehospital clinicians. Topics: Ultrasound, sonography, prehospital clinicians, emergency medical services (EMS), paramedics, critical care transport, extended focused assessment with sonography in trauma (E-FAST), free fluid, sliding lung sign, elective, pain.

Prehospital Use of Waveform Capnography in Intubated Neonates.

INTRODUCTION: Routine continuous monitoring of endotracheal tube placement with waveform capnography is considered standard of care in the prehospital setting. However, maintaining this standard in neonatal patients remains a challenge due to low tidal volumes that do not tolerate the additional dead space ETCO2 attachments add. Additionally, continuous ETCO2 can increase the risk of ETT dislodgement or kinking because of the weight and size of the capnography attachments relative to the patient and tube size. We hypothesize that there is a gap in care of intubated neonates when compared to adults in the prehospital setting in terms of continuous monitoring of ETT placement. METHODS: Data were obtained from a single air medical agency. Through a retrospective chart review, records of intubated neonates (<28 days), children (≥28 days-12 years), adolescents (13-18 years), and adults (aged ≥18 years) were analyzed. Records were available from 11/21/13-1/21/22. The number of intubation attempts, whether an intubation was successful, and the use of capnography were recorded in RedCap. Statistical analysis was performed in Microsoft Excel via Chi Square Goodness of Fit Tests. RESULTS: During the study period, 674 intubation attempts were identified, and 28 charts were excluded due to missing patient age. Continuous waveform ETCO2 monitoring was used on 62%, 94%, 95%, and 97% of successfully intubated neonates, children, adolescents, and adults, respectively. There was a statistically significant difference between use of continuous waveform capnography in adults and neonates (p-value = 0.013). There was also a statistically significant difference between use of continuous waveform capnography in intubated neonates, children, and adolescents (p-value = 0.049). CONCLUSION: Continuous ETCO2 monitoring is underutilized in intubated neonates compared to children, adolescents, and adults in the prehospital setting in this study population. This suggests a gap in the standard of care provided to neonates. Additional studies are needed to determine if these results are consistent around the industry and if there is a higher rate of undetected tube displacement in neonates who are transported without waveform capnography.

Ground Versus Air: Which Mode of Emergency Medical Service Transportation Is More Likely to Crash?

OBJECTIVE: We analyzed helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) crash data in the United States during 1983 to 2020 to compare incidences of total, fatal, and injury crashes. METHODS: HEMS and GEMS total, fatal, and injury crashes during 1983 to 2020 and 1988 to 2020, respectively, were analyzed in this retrospective study. Data were obtained from the National Transportation Safety Board and the National Highway Traffic Safety Administration. Additional data from the Federal Aviation Administration, the National Emergency Medical Services Information System, and prior literature were used for rate calculations. A Poisson regression model was used to determine rate ratios with 95% confidence intervals comparing total, fatal, and injury crash rates from 2016 to 2020. RESULTS: HEMS crash rates decreased since 1983. Total GEMS crashes have increased since 1988. Of the total crashes, 33% (HEMS) and 1% (GEMS) were fatal, and 20% (HEMS) and 31% (GEMS) resulted in injury. During 2016 to 2020, GEMS crash rates were 11.0 times higher than HEMS crash rates (95% confidence interval, 5.2-23.3; P < .0001). CONCLUSION: HEMS has a lower crash probability than GEMS. The availability of data is a limitation of this study. National GEMS transportation data could be useful in studying this topic further.