Page 25 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

ultrasonography to evaluate our own practice and to add to the literature.
Ultrasonography beyond the HEMS
HEMS physicians are involved in ultrasonography outside of the scope of the HEMS.
A handful of HEMS physicians (in collaboration with emergency physicians and an ortho- pedic surgeon) are involved in the PREP ultrasound course, as discussed hereabove. They are enthusiastic about emergency ultrasonography and have been motivated to teach the skill to many colleagues over the years. Many candidates completed the course, including emergency physicians, anesthesiologists, surgeons, HEMS physicians, internists, intensivists and Dutch army medical imaging technologists.
Besides teaching, Nijmegen emergency physicians (EPs) and HEMS physicians are collab- orating since 2014 to introduce UGRA in the emergency department. The EPs purchased a modern portable ultrasound device, equipped with three transducers, to be used for more than UGRA alone, obviously. Together they developed a one-day UGRA course for EPs and emergency medicine residents. Subsequently, they started performing nerve blocks; mainly femoral nerve blocks in patients with proximal femoral fractures. On request, (resident) anesthesiologists supervised the performance of the blocks. The EPs carried out continuous and accurate quality control by keeping a record of all nerve blocks.
Future
The quality and portability of ultrasound devices is increasing. Simultaneously, their size, weight, and price are coming down. Also, the body of evidence in the literature and the number of indications is growing. Therefore, ultrasonography will be embraced by a growing number of health care workers and it will be applied in a growing number of patients to improve decision-making and the care they receive. And ultimately benefits in morbidity and mortality will become apparent. Potential future PHUS applications will be discussed in Chapter 2 and Chapter 10.
With the growing adoption and utility of ultrasonography, few will be surprised that it has been called “the visual stethoscope of the 21th century”.16 And this might be especially true in the dynamic and noisy prehospital environment.
Introduction, aims, and outline of this thesis 23
1