Page 216 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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Chapter 10
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Figure 10.1 We suggest to extend the chain of survival with a fifth element Focused echocardiography can be used to find treatable causes of cardiac arrest.
Research in prehospital emergency medicine is challenging because of the time-critical na- ture of the operation, the dynamic environment, and the high degree of heterogeneity in cases. Heterogeneity in the level of training and experience is also a factor. Due to limited physical space and operational limitations, helicopters, EMS vehicles, and their crews do not readily allow independent researchers to accompany the health care workers to ensure a standard level of data collection. For instance, a helicopter is able to lift only a limit- ed amount of weight. The consequence of adding an additional 80 kg observer is that the amount of fuel must be reduced by 80 kg and hence the HEMS's range of operation will be significantly reduced. Moreover, performing CPR in the back of a moving ambulance hardly leaves any physical space for an extra observer to perform measurements.
Nonetheless, future research in prehospital ultrasonography could be aimed in a few distinct directions. First, it could be directed towards larger—international—multicenter studies in- volving larger samples with proper randomization and follow-up to allow the investigation of outcome parameters including morbidity and mortality. For example a thorough evalua- tion of prehospital focused cardiac ultrasonography during CPR or lung ultrasonography in the assessment for pneumothorax. Secondly, novel applications—such as airway evaluation or the confirmation of intraosseous vascular access needle placement—could be explored prospectively in pilot studies to prepare for the design of larger multicenter follow-up stud- ies.
  
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