Page 153 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Abdominal prehospital ultrasound impacts treatment decisions in a Dutch helicopter emergency medical service 151
Introduction
The use of diagnostic ultrasound is becoming ever more common and plays an important part in emergency medicine worldwide.1 As a reliable, quick, low cost, and harmless diag- nostic tool for emergency care providers, its relevance and utility in emergency medicine are highly regarded.2,3 This is especially true when acute intra-abdominal hemorrhage is suspect- ed, associated with blunt abdominal trauma resulting from prevalent trauma mechanisms such as falls from heights and road traffic accidents (RTA).4 It is a significant factor for mortality after trauma and requires quick intervention since treatment delay decreases sur- vival.5,6 The development and introduction of portable ultrasound devices reduced this delay, and the feasibility and utility of prehospital ultrasound (PHUS) in prehospital emergency medicine are demonstrated.7–9
PHUS has been introduced in (Helicopter) Emergency Medical Services ([H]EMS) and im- pacts prehospital patient care such as a switch to scoop-and-run tactics, mode of transport and choice of destination hospital.10–12 Although some research on the subject is available, recent reviews conclude that the positive contribution of abdominal (PH)US is feeble.13,14 Prehospital health care providers in some parts of the world still refrain from PHUS because of an unconvincing cost-benefit analysis.15 Research on ultrasound in prehospital emergency medicine was recently appointed to be a top five priority by a European research collabora- tion.16
Many studies on PHUS in trauma patients include both thoracic and abdominal injury. Our previous study showed a positive contribution of PHUS in chest injuries.11 Studies focusing on abdominal injuries are scarce. The objective of this study is to determine the impact of abdominal PHUS on patient care in our region.
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