A National Survey of Prehospital Care Services of United Kingdom for Use, Governance and Perception of Prehospital Point of Care Ultrasound

Abstract

Introduction: Point of care ultrasound (POCUS) has become a common practice in prehospital care over the last 10 years. There is lack of literature on its use and governance structure in United Kingdom (UK) prehospital care services. We aimed to survey the use, governance of prehospital POCUS among UK prehospital services and perceptions of clinicians and services regarding its utility and barriers to its implementation. Methods: Four electronic questionnaire surveys were delivered to UK helicopter emergency medical service (HEMS) & clinicians, ambulance and community emergency medicine (CEM) services between 1st of April and 31st of July 2021 investigating current use, governance structure for POCUS and perception about its benefits and barriers. Invitations were sent via email to medical directors or research leads of services and using social media. Survey links remained live for two months each. Results: Overall, 90%, 62% and 60% of UK HEMS, ambulance and CEM services respectively, responded to surveys. Most of the services used prehospital POCUS, however only two HEMS organisations fulfilled the Royal College of Radiology governance criteria for POCUS. The most commonly performed POCUS modality was echo in cardiac arrest. Majority of clinicians judged POCUS to be beneficial and the common perceived benefit was promotion of enhanced and effective clinical care. Major barriers to its implementation included a lack of formal governance, limited literature supporting its use and difficulties in performing POCUS in prehospital environment. Conclusion: This survey demonstrates that prehospital POCUS is being provided by a majority of the prehospital care services and clinicians have found it beneficial in providing enhanced clinical care to their patients. However, the barriers to its implementation are relative lack of governance structure and supportive literature.

Prehospital Standards for Point of Care Ultrasound

“…In a recent survey similar to ours, providers in the UK identified lack of prehospital PO-CUS governance as a major barrier to the use of this tool, despite perceiving it as beneficial for patient care (Naeem et al, 2022); these findings suggest a standardized accreditation process could assist with rolling out of POCUS in the prehospital environment. Furthermore, given that current literature provides conflicting data on the efficacy of POCUS in the hands of paramedics specifically (Becker et al, 2018;Donovan et al, 2022;Nadim et al, 2021;Pietersen et al, 2021;Schoeneck et al, 2021), the current lack of standardization for prehospital POCUS represents a potential opportunity for improved patient care.…”

“…Another challenge facing the expansion of POCUS to prehospital care in Canada and elsewhere in the world is a lack of literature on the subject (Naeem et al, 2022). While prehospital POCUS is known to change patient management in select circumstances, it's effect on patient outcomes remains largely unknown, presenting an exciting area of future research (Amaral et al, 2020;Bøtker et al, 2018).…”

Implementation of a point-of-care ultrasound archiving system and governance framework in a UK physician-paramedic staffed helicopter emergency medical service

“…This guidance was expanded by the BMUS and the Royal College of Radiologists (RCR) in 2023 to include recommendations for regular audit of recorded scans to perform QA and facilitate learning [ 8 ]. Despite this, less than a third of UK EMS utilise imaging archiving for POCUS, and fewer review saved images for clinical governance [ 1 ].…”

“…There has been a rapid expansion in the use of point-ofcare ultrasonography (POCUS) by UK prehospital emergency medical services (EMS) [1]. Prehospital POCUS is feasible and has been shown to enhance clinical assessment and diagnosis, aid decision making, and facilitate ultrasound-guided interventions [1][2][3][4].…”

“…There has been a rapid expansion in the use of point-ofcare ultrasonography (POCUS) by UK prehospital emergency medical services (EMS) [1]. Prehospital POCUS is feasible and has been shown to enhance clinical assessment and diagnosis, aid decision making, and facilitate ultrasound-guided interventions [1][2][3][4]. However, the reported diagnostic accuracy of prehospital POCUS is variable, and there is a paucity of literature on the quality of prehospital POCUS examinations [5,6].…”