Remote Real-Time Ultrasound Supervision via Commercially Available and Low-Cost Tele-Ultrasound: a Mixed Methods Study of the Practical Feasibility and Users' Acceptability in an Emergency Department.

Minor emergency departments (ED) struggle to access sufficient expertise to supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using tele-ultrasound (tele-US) for remote supervision may remedy this situation. We aimed to evaluate the feasibility of real-time supervision via tele-US when applied to an everyday ED clinic. We conducted a mixed methods study that assessed practical feasibility, determined performance, and explored users' acceptability of supervision via tele-US. Technical performance was assessed quantitatively by the ratio in mean gray value between images on site and as received by the supervisor, and by after-compression frame rate. Qualitatively, 12 exploratory semi-structured interviews were conducted with exposed junior doctors and supervisors. Remote supervision via tele-US was performed with 10 junior doctors scanning 45 included patients. During performance assessment, neither alternating internet connection nor software significantly changed the mean gray value ratio. The lowest median frame rate of 4.6 (interquartile range [IQR]: 3.1-5.0) was found by using a 4G internet connection; the highest of 28.5 (IQR: 28.5-29.0) was found with alternative computer and local area network internet connection. In interviews, supervisors stressed the importance of preserving frame rate, and junior doctors emphasized a need for shared ultrasound terminology. In the qualitative analysis, setup mobility, accessibility, and time consumption were emphasized as being of key importance for future clinical implementations. Remote supervision via a commercially available and low-cost tele-US setup is operational for both junior doctors and supervisors when applied to lung and cardiac POCUS scans of hospitalized patients.

Limited public ability to recognise and understand the universal sign for automated external defibrillators.

OBJECTIVE: To study if the public is able to recognise and understand the International Liaison Committee on Resuscitation (ILCOR) sign for automated external defibrillators (AEDs), and to explore how national resuscitation councils have adopted the sign. METHODS: A survey was conducted among travellers in an international airport serving 21 million passengers annually. Participants were asked to state the meaning of six international safety signs, one of which was the ILCOR AED sign. Also, all national resuscitation councils forming ILCOR were contacted to determine whether they recommend the ILCOR AED sign and the existence of national legislation regarding AED signage. RESULTS: In total, 493 travellers (42 nationalities) were included. Correct identification of the ILCOR AED sign was achieved by 39% (95% CI 35% to 43%). Information on AED signage was obtained from 41 of 44 (93%) national resuscitation councils; 26 councils (63%) recommended the use of the ILCOR AED sign. In two countries, the ILCOR AED sign was mandatory by law. CONCLUSIONS: There is limited public recognition and understanding of the ILCOR AED sign. The ILCOR AED sign is not unanimously recommended by national resuscitation councils worldwide. Initiatives promoting public awareness of AEDs are warranted.