Educational standards for training paramedics in ultrasound: a scoping review

Abstract

BackgroundParamedic-performed out-of-hospital ultrasound is a novel skill that has gained popularity in some services in recent years. In this setting point-of care ultrasound (POCUS) can provide additional information that can assist with management and guide transport to the most appropriate facility. We sought to explore the different educational approaches used for training paramedics in ultrasound in the out-of-hospital setting.MethodsOvid MEDLINE, EMBASE, EBM Reviews, The Cochrane Library, CINAHL plus, The Monash University Research Repository and the British Thesis Library were searched from the 1st of January 1990 to the 6th of April 2016. Google Scholar was searched and reference lists of relevant papers were examined to identify additional studies. Articles were included if they reported on out-of-hospital and POCUS educational approaches for paramedics.ResultsA total of 2002 unique articles were identified of which 18 articles met the inclusion criteria. Most articles reported combined cohorts of emergency providers with varying years of experience though most operators were POCUS naïve. The most common clinical assessment for which paramedic POCUS curricula was described was the focused assessment sonography for trauma (FAST) examination. Education programs varied from two-minutes to two-days with all studies including both didactic and practical training.ConclusionEducation programs for POCUS for paramedics vary considerably, and do not appear to align with qualification level or clinical experience. Further research investigating education and subsequent clinical application of POCUS by paramedics is required, as well as prospective, outcome based studies in order to measure the clinical utility of out-of-hospital POCUS.

Prehospital point-of-care ultrasound: A transformative technology

“…Individual studies show a trend toward adequate skill retention; however, methodology and robustness of data are limited. 22,[46][47][48] A common theme in prehospital emergency care is difficulty to maintain proficiency with low-volume, high-risk procedures (e.g. endotracheal intubation, cricothyrotomy, and thoracostomy).…”

“…Individual studies show a trend toward adequate skill retention; however, methodology and robustness of data are limited. 22 , 46 – 48 …”

“…In general, training programs included didactic and practical training, with some successfully implementing blended online and in-person curricula. 22 There is a paucity of literature regarding the education practicing prehospital clinicians have obtained outside of feasibility studies or pre-implementation surveys. However, in two studies, paramedics with advanced training or significant experience demonstrated higher degrees of accuracy in lung ultrasound.…”

Diagnostic Accuracy of Extended Focused Assessment with Sonography for Trauma Performed by Paramedic Students: A Simulation-Based Pilot Study

“…Although several articles have shown the benefit of EFAST for physicians in the prehospital setting, the benefit of performing prehospital EFAST by Thai paramedics has not been investigated. 7 , 8 , 11 , 12 To date, numerous ultrasound curricula have been developed according to the literature, but there has been no standardized training to establish the clinical outcome, especially for the middle-income countries. 13 The duration of the curricula varied from 1 h to 2 days, and most of curricula comprised both didactic lecture and practical session.…”

Paramedic point of care ultrasound at Australian mass gatherings

“…This select case series was collected between August 2017 and February 2018 and describes the first known series of patient care cases in which expanded point of care ultrasound (POCUS) was performed by a paramedic in a festival and event medicine context in Australia. The expanded approach to POCUS differs from its regular use by paramedics in that it relies on a wide array of organ‐system examinations that lie outside the remit of general pre‐hospital POCUS use; largely the extended focused assessment with sonography in trauma (eFAST) and focussed cardiac ultrasound examinations . The expanded use of POCUS was felt to have contributed to the care of patients in this relatively resource‐limited environment.…”