Portable ultrasonography in mass casualty incidents: The CAVEAT examination

Abstract

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.

Wilderness medicine

“…[132,133] Disaster medicine has used ultrasound in the field and in hospitals when other resources are overwhelmed or unavailable. [134][135][136][137][138] These situations often employ ultrasound for the focused scans delineated in ACEP's Emergency Ultrasound Guidelines. [139] The use of ultrasound in conjunction with telemedicine is intriguing.…”

Modern sonology and the bedside practitioner: evolution of ultrasound from curious novelty to essential clinical tool

“…For example, sonologists and proceduralists can claim substantial contributions in the areas of central [13] and peripheral [14] venous access, disaster triage [15], musculo-skeletal diagnosis and treatment [16,17], vascular diagnosis [18], intravascular volume status assessment [19], cardiovascular assessment [20,21], tracheal airway placement verification [2], ophthalmologic and neurologic applications [22][23][24][25], diagnosis of cholecystitis [26,27], appendicitis [28], and abdominal solid organ abnormalities [29][30][31][32], obstetric and gynecologic applications [33,34], and percutaneous drainage of fluid collections [35,36], among many other clinical uses [37][38][39][40][41].…”

Advancing clinician-performed sonography in the twenty-first century: building on the rich legacy of the twentieth century pioneers

“…Now, ultrasound is finding a role even earlier in the care of the patient, including the pre-hospital arena where studies are performed by emergency medical providers to assist in decisions regarding triage and resource allocation [29]. Point-of-care sonography has been used successfully in developing countries, resource-poor areas, and mass casualty/disaster settings [6,30].…”

“…Now, ultrasound is finding a role even earlier in the care of the patient, including the pre-hospital arena where studies are performed by emergency medical providers to assist in decisions regarding triage and resource allocation [29]. Point-of-care sonography has been used successfully in developing countries, resource-poor areas, and mass casualty/disaster settings [6,30].Supporters of ultrasound technology have touted it to be the "new stethoscope" of the twenty-first century, moving it conceptually from its traditional role as a diagnostic modality to a necessary and central part of a good physical examination performed by a medical practitioner [31,32]. This moniker illustrates the ubiquitous nature of ultrasound application.…”

“…Within 20 years of its initial clinical use, scientists had advanced the technology to a point where ultrasound machines were much more compact and offered image quality sufficient to evaluate the fetus in obstetrics care [4]. Since then, diagnostic applications of sonography have incrementally increased to encompass literally every field of health care, from physical medicine and rehabilitation to obstetrics and gynecology, emergency medicine to pulmonology, critical care to disaster management, oncology to trauma and emergency surgery, and pediatrics to gastroenterology [5][6][7][8][9][10].As clinical applications of ultrasound have expanded and image resolution has improved, the actual sizes of machines and probes have progressively become smaller [11][12][13]. This portability has allowed ultrasound studies to occur at a patient's bedside, largely eliminating the need for * S. P. Stawicki…”