Page 209 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

by Gerritse.2
In Chapter 4, we presented the elaborate report of this qualitative study. We concluded that Dutch EPs were highly motivated, but encountered many obstacles implementing ultraso- nography in their EDs. Furthermore, they expressed the need for a certification system that allows recording their examinations and have experienced colleagues review the recorded scans when appropriate. Incentives for the EPs to start using ultrasonography were: (1) they had completed the course itself and acquired a new set of skills, (2) they were inspired by col- leagues, and (3) they felt ultrasonography would be an important new tool in the emergency department. Important obstacles were a lack of confidence in their new skills, the lack of an actual ultrasound machine in the ED, and challenging cooperation with the radiologists.
It must be noted that although we reached data saturation after eight interviews, it is con- ceivable that a repeated series of interviews with another sample of comparable EPs could yield slightly different results. This is even more likely when such interviews were repeated today. The original interviews were conducted in 2014. Another weakness of this qualitative study is that it will be difficult to translate the results to ultrasound courses, EPs, and ED systems in other countries. Nevertheless, that was not the aim of the study.
As mentioned above, the interviews were conducted in 2014. Meanwhile, the Dutch national association of emergency physicians (Nederlandse Vereniging van Spoedeisende Hulp Art- sen [NVSHA]) implemented ultrasonography as an integral part of the training of emergen- cy medicine residents and adopted a certification program. Also, many Dutch EPs managed to implement ultrasonography in their EDs. They started using it for a myriad of indications, including eFAST, lung ultrasound, focused cardiac ultrasonography, ultrasound-guided re- gional anesthesia, and the evaluation of the deep venous system of the legs. Other examples of indications in the ED are the assessment for intrauterine pregnancy, of the urinary tract, acute right iliac fossa pain, and bone fractures. Many of these applications were discussed in Chapter 2 when deemed feasible for emergency prehospital use.
Because of these recent developments, it would be interesting to conduct a follow-up study to evaluate the current experiences of EPs and to make a comparison with the experiences we described.
As part of HEMS physicians’ efforts reaching out to the ED, we developed a training in ul- trasound-guided regional anesthesia (UGRA), intended for EPs and residents. In a one-day course, we discussed, demonstrated, and practiced the performance of the ‘blind’ fascia iliaca compartment block and ultrasound-guided blocks of the femoral nerve and the nerves of the distal upper and lower extremity. In parallel, we devised a supervision system in which an
Summary, discussion, and future perspective 207
10