Page 21 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

The introduction of ultrasonography in emergency medicine has now made it possible to diagnose these conditions with far greater accuracy. In 1988 Filly recognized ultrasound to potentially be the ‘stethoscope of the future’ although he expressed some concerns about nonradiologists adopting ultrasonography.14 Also, Isono stated in an editorial in Anesthesi- ology that “perhaps the stethoscope is closer to a costume piece than ever before,” meaning that its days might be numbered since the advent of ultrasonography.15 Others also recog- nized that ultrasonography may well be ‘the stethoscope of the 21th century’ and might one day replace it.16,17
For a long time, (noncardiac) ultrasonography was solely the domain of radiologists. When nonradiologists such as emergency physicians started embracing point-of-care ultrasonog- raphy (PoCUS), many radiologists were concerned about substandard quality of diagnostic imaging that would negatively impact patient care, safety, and related costs.18,19 In more recent years, however, PoCUS by nonradiologists has become more common. Nevertheless, the discussion in literature continues.20–23
Ultrasonography in Dutch helicopter emergency medical services (HEMS)
Prehospital emergency ultrasonography was introduced in the Netherlands in 2006 by Gerri- tse, Dirven, and Huig.24 From Nîmes, France, they imported an emergency ultrasound train- ing called the Programme Rapide d’Échographie d’un Polytraumatisé or Polytrauma Rapid Echo-evaluation Program (PREP). The PREP philosophy is to seek the answer to a primary set of simple yes/no questions: are there any signs of a (large) pneumothorax, hemothorax, free intraperitoneal fluid or air, pericardial effusion, or an aneurysm of the abdominal aor- ta?24 Apart from the abdominal aorta measurement, the PREP approach is similar to the extended focused assessment with sonography for trauma (eFAST).25
The first course was organized on February 2nd, 2006 in Loosdrecht, the Netherlands. Si- multaneously, the HEMS of Nijmegen and Rotterdam adopted the advantages of PHUS by bringing a portable ultrasound machine to emergencies. In the years to come, many HEMS physicians and emergency physicians (amongst others) successfully completed the course. After the course has been running for some years, we were interested in what kind of im- pact the PREP training had made on the use of ultrasound by emergency physicians in daily practice. How did they handle the implementation of ultrasonography in Dutch emergency departments?
In the Nijmegen HEMS, the first ultrasound machine we carried on board was a Fujifilm SonoSite® MicroMaxx® ultrasound device (Figure 1.8). Later, it was replaced by the more compact and robust NanoMaxx® device (Figure 1.9). A few years later, it was superseded by
Introduction, aims, and outline of this thesis 19
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