Remote real-time supervision of prehospital point-of-care ultrasound: a feasibility study

Abstract

Background Although prehospital point-of-care ultrasound (POCUS) is gaining in importance, its rapid interpretation remains challenging in prehospital emergency situations. The technical development of remote real-time supervision potentially offers the possibility to support emergency medicine providers during prehospital emergency ultrasound. The aim of this study was to assess the feasibility of live data transmission and supervision of prehospital POCUS in an urban environment and so to improve patients’ safety. Methods Emergency doctors with moderate ultrasound experience performed prehospital POCUS in emergency cases (n = 24) such as trauma, acute dyspnea or cardiac shock using the portable ultrasound device Lumify™. The ultrasound examination was remotely transmitted to an emergency ultrasound expert in the clinic for real-time supervision via a secure video and audio connection. Technical feasibility as well as quality of communication and live stream were analysed. Results Prehospital POCUS with remote real-time supervision was successfully performed in 17 patients (71%). In 3 cases, the expert was not available on time and in 1 case remote data transmission was not possible due to connection problems. In 3 cases tele-supervision was restricted to video only and no verbal communication was possible via the device itself due to power saving mode of the tablet. Conclusion Remote real-time supervision of prehospital POCUS in an urban environment is feasible most of the time with excellent image and communication quality. Trial registration: ClinicalTrials Number NCT04612816.

Prehospital Standards for Point of Care Ultrasound

“…Additionally, the actual use of POCUS by trained providers has been shown to increase as time spent training increases, underscoring the importance of supervised scanning to allow practitioners to become comfortable using this tool (Leschyna et al, 2019). Concerns regarding the accuracy of POCUS interpretation by prehospital providers could be mitigated by real-time interpretation of prehospital practitioner-generated images by a radiologist or other trained provider (Hermann et al, 2022).…”

“…In the hospital, point-of-care ultrasound (POCUS) has become an increasingly popular bedside tool for the assessment of similarly undifferentiated patients by emergency physicians, allowing for early and accurate diagnosis of life-threatening diagnoses such as ectopic pregnancy, abdominal aortic aneurysm, and cardiogenic shock (Lewis et al, 2019). Recent technological advances have allowed for the expansion of handheld POCUS to the prehospital environment, offering an innovative way for prehospital practitioners to improve their diagnostic accuracy (Hermann et al, 2022;Smallwood & Dachsel, 2018). Moreover, several studies have identified the feasibility of POCUS by non-physicians (Amaral et al, 2020;Becker et al, 2018;Bøtker et al, 2018;Laursen et al, 2016;Nadim et al, 2021;Pietersen et al, 2021), with non-physician practitioners identifying conditions such as cardiogenic pulmonary edema and abdominal aortic aneurysm with high sensitivity and specificity (Laursen et al, 2016;Schoeneck et al, 2021).…”

Conservative management of adnexal tumors: how to tell good from bad

“…Rather than focusing on supporting individuals who are practicing on their own, services could be reconfigured in a way that would facilitate closer teamwork. With the assistance of modern communication technology, it would be relatively easy to organize services such that expert examiners could support directly, or remotely, a relatively large number of sonographers in real time 16 . This support could include assistance with technical aspects of the examination, help with diagnosis and advice on management and follow‐up.…”

Point‐of‐care ultrasonography—An essential skill for medical graduates?

“…Modernisation of communication technologies allowed to deliver POCUS to the prehospital setting using remote real-time supervision by a trained specialist. 6 The COVID-19 pandemic further exposed limitations of traditional clinical chest auscultation 7 and non-bedside diagnostics that required in-hospital and interhospital patient transport. This led to an 'explosion' of POCUS during the surge crisis.…”

“…The expansion can be in part explained by the significant miniaturisation and reduced costs of ultrasound scanners, incorporation of artificial intelligence and gradually increased number of trainers in all medical specialties. Modernisation of communication technologies allowed to deliver POCUS to the pre‐hospital setting using remote real‐time supervision by a trained specialist 6 . The COVID‐19 pandemic further exposed limitations of traditional clinical chest auscultation 7 and non‐bedside diagnostics that required in‐hospital and interhospital patient transport.…”