Page 146 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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Chapter 6
ing quality refers to chest or abdominal US or both.
According to some authors, a structured US examination according to the FAST method must not take longer than 3 minutes.4,18,19 The PREP method we use is comparable to the FAST and dictates that an examination is to be completed in under 3 min. The average du- ration in our study was 2.77 min with a range of 0–10 min. The time it took the physician to complete an examination decreased in 2009 and 2010 compared to the two previous years. This is likely a learning effect. Within our HEMS there were two enthusiastic physicians who used the US machine and were PREP/eFAST-trained before we started using US in 2007. As time progressed, all HEMS physicians became trained and experienced in using US in general and our portable US machine in particular, possibly contributing to a faster US examination.
The time an examination requires is not always so important. US is often used during trans- port of a patient to the hospital. This causes no delay because the patient is already under- way, while providing the physician with additional information.
That prehospital US can change treatment decisions was shown by Walcher.18 They studied the use of prehospital US with blunt abdominal trauma in a German prehospital setting and showed that US yielded a change of prehospital therapy or management in 30% of the patients and the choice for the admitting hospital was changed in 22%.18 We found that US of the chest changed these decisions in 21% and 4% of our patients, respectively. In general, Ger- man trauma victims are more often transported for a second time to a Level I trauma center after primary assessment and treatment has been carried out at a lower-level hospital.20 This approach is different from the way prehospital medical care is organized in the Netherlands.
We diagnosed a pneumothorax in 25 patients, whereas we found a hemothorax in only 2. A hemothorax is associated more often with penetrating injury or with injuries associated with a high-energy trauma mechanism. In patients suffering hemothorax, it is perhaps better to omit the US examination and choose to immediately insert a chest tube and transport them to the nearest suitable hospital.
Due to results of previous studies, our findings, and the useful information that can be gleaned from US examinations, none of the PREP-trained HEMS physicians will scramble without the portable US unit anymore.
Limitations
 Due to the retrospective nature of this study, some data are missing. Sometimes when the US
 
























































































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