Page 24 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 1
the pilot in-flight by maintaining a safe lookout and with emergency procedures. On-scene, the HCM is involved in patient care. The physicians are medical specialists: either a trau- ma surgeon or an anesthesiologist. They have experience and are trained in the care for the (prehospital) injured and critically ill patients. One mandatory element of that training is a PREP or eFAST ultrasound course.
The evolution of ultrasonography in Dutch HEMS
Initially, PHUS was used for the indications taught to the Dutch HEMS physicians in the PREP course. These include the detection or exclusion of a pneumothorax, hemothorax, free intraperitoneal fluid or air, pericardial effusion, and an abdominal aorta aneurysm.24
Later, the HEMS physicians started using PHUS for additional indications. Ultrasound-guid- ed airway management (discussed in Chapter 2) has been used to assess the airway before intubation or to visualize the larynx and proximal esophagus in real-time while an attempt was made to intubate the trachea.
Also, ultrasound-guided regional anesthesia (UGRA) (Chapter 5) was recognized to be of benefit in patients with extensive extremity injuries. UGRA proved to be especially useful in patients with a trapped arm or leg that prevented them leaving the incident location. Supe- rior pain relief can be achieved while it might take some amount of time for their extremities to be released and for in-hospital loco-regional pain treatment or surgery to be started.
Optical nerve sheath diameter (ONSD) measurements (Chapter 9) were carried out to de- tect a possible rise in intracranial pressure (ICP) as a sign of intracranial pathology. It might support the decision to either transport the patient to a neurosurgical center or to the near- by general hospital.
Nowadays, PHUS has become an established diagnostic tool in Dutch HEMS. This devel- opment did not go unnoticed by the ground ambulance services. Occasionally, they even request the HEMS to proceed to the incident location, specifically to perform diagnostic ultrasonography. In the not too distant future, ground ambulance nurses will, without a doubt, perform their own PHUS scans.
The body of literature on emergency ultrasonography in the prehospital setting, however, is still relatively manageable. Especially in the early days of this PhD project, the papers on, for instance, prehospital chest ultrasonography and prehospital peri-resuscitation focused car- diac ultrasonography were scarce. Papers on prehospital ONSD measurements were non-ex- istent. Therefore, in the Nijmegen HEMS, the need arose to evaluate the use of prehospital