Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics

Abstract

Introduction Advances in the portability of ultrasound have allowed it to be increasingly employed at the point of care in austere settings. Battlefield constraints often limit the availability of medical officers throughout the operational environment, leading to increased interest in whether highly portable ultrasound devices can be employed by military medics to enhance their provision of combat casualty care. Data evaluating optimal training for effective medic employment of ultrasound is limited however. This prospective observational cohort study’s primary objective was to assess the impact of a 4-hour introductory training intervention on ultrasound-naïve military medic participants’ knowledge/performance of the eFAST application. Materials and Methods Conventional U.S. Army Medics, all naïve to ultrasound, were recruited from across JBLM. Volunteer participants underwent baseline eFAST knowledge assessment via a 50-question multiple-choice exam. Participants were then randomized to receive either conventional, expert-led classroom didactic training or didactic training via an online, asynchronously available platform. All participants then underwent expert-led, small group hands-on training and practice. Participants’ eFAST performance was then assessed with both live and phantom models, followed by a post-course knowledge exam. Concurrently, emergency medicine (EM) resident physician volunteers, serving as standard criterion for trained personnel, underwent the same OSCE assessments, followed by a written exam to assess their baseline eFAST knowledge. Primary outcome measures included (1) post-course knowledge improvement, (2) eFAST exam technical adequacy, and (3) eFAST exam OSCE score. Secondary outcome measures were time to exam completion and diagnostic accuracy rate for hemoperitoneum and hemopericardium. These outcome measures were then compared across medic cohorts and to those of the EM resident physician cohort. Results A total of 34 medics completed the study. After 4 hours of ultrasound training, overall eFAST knowledge among the 34 medics improved from a baseline mean of 27% on the pretest to 83% post-test. For eFAST exam performance, the medics scored an average of 20.8 out of a maximum of 22 points on the OSCE. There were no statistically significant differences between the medics who received asynchronous learning versus traditional classroom-based learning, and the medics demonstrated comparable performance to previously trained EM resident physicians. Conclusions A 4-hour introductory eFAST training intervention can effectively train conventional military medics to perform the eFAST exam. Online, asynchronously available platforms may effectively mitigate some of the resource requirement burden associated with point-of-care ultrasound training. Future studies evaluating medic eFAST performance on real-world battlefield trauma patients are needed. Skill and knowledge retention must also be assessed for this degradable skill to determine frequency of refresher training when not regularly performed.

Focused Evaluation With Ultrasound in Thoracoabdominal Trauma

“…Fluid volumes from 100ml collected at the abdominal level (hemoperitoneum), can be detected with ultrasound assessment, and at the thoracic level from 5ml can be observed (hemothorax and pleural effusion), however, this is directly proportional to the operator's capacity (Monti & Perreault, 2020).…”

“…To facilitate the visualization of free fluid in the pelvic cavity, it is ideal for the bladder to be filled with fluid or for the bladder to be distended; and when there is free fluid, it is located in the posterior or upper part of the bladder or uterus in the case of women (Monti & Perreault, 2020). This can be interrupted in the detection of free fluid when the patient is previously placed a bladder catheter and the bladder is completely emptied, and if there is a compromise of the acoustic window it can only be detected if it occupies large amounts of free fluid (Carrera Sieiro JC et al, 2020).…”

The ultrasound use of simulators, current view, and perspectives: Requirements and technical aspects (WFUMB state of the art paper)

“…Ultrasound learners can now develop image acquisition, interpretation, and procedure skills through a variety of simulation technologies. [ 7 , 88 , 92 93 94 95 96 97 98 99 100 101 102 103 104 ] Additional ultrasound simulation applications have been developed to further assess how well learners can integrate ultrasound findings into clinical decision-making. [ 99 , 105 ]…”

FAST Performance in a Stationary versus In-Motion Military Ambulance Utilizing Handheld Ultrasound: A Randomized Controlled Study

“…24 Previous research has shown emergency medical technicians can be trained in trauma sonography after a brief training intervention to achieve results comparable to physicians. [25][26][27] Participants performed all FASTs on an US phantom model, not a live human model or an actual trauma patient. This limits generalizability as patient factors such as obesity, difficult sonographic windows, movement, pain, altered mentation, and several others may complicate FAST performance.…”