Pre-hospital (paramedic) US: Re-appreciating the Golden Hour…

HAPPY EMS WEEK!!!! We so appreciate all that you do! Along those lines…… and along with many others all over the world in years past, at Stanford there has been a 2-part study being done supervised by Drs. Sarah Williams and Jessica Pierog (PEEPS study) and at UCI supervised by Dr. Chris Fox and others (PAUSE protocol) on the prehospital use/acquisition/ interpretation of emergencies visible by bedside US.  It is evident (an understatement, actually) that US needs to go into our ambulances. This, of course, is nothing new. People have been talkin’ and talkin’ about all of the studies done in this arena for YEARS! Actually, from the late 1990s on….We know this: US is not hard and, thanks to the increasing portability of it, more should use it. How many studies does it take? Its like that joke, “how many (fill in the blank) does it take to (fill in the blank)?” Of course, the Europians are already implementing this. Seriously (picture my serious face, which is rarely seen, but this deserves it), to all my EMS directors out there in the world, any who can and want to make a difference in prehospital care with regard to bedside US – lets do this! We are all here to help you! Maybe we should ask for forgiveness instead of for permission?

Imagine the patient who EMS picks up, appearing intoxicated “found down” maybe even a homeless guy who is tachycardic (which homeless alcoholic isnt, right?) and a bedside FAST is performed on the way to a non trauma center…and it’s POSITIVE! They quickly redirect to a trauma center and get that patient the ultimate care they need in a timely fashion.

Or, lets say it IS a trauma patient, who was in a MVC at moderate/high speed c/o right sided pain with stable/normal vitals. They do a FAST and it’s positive – immediately the receiving facility is on high alert (may even order blood products and get the OR ready) and not surprised when the patient begins to decline on approach. Or, what if they do a thoracic US and its positive for pneumothorax? – good to know early, and prior to any intubation, right? Or, maybe even the most important for emergent intervention is if they see an expanding pericardial effusion on a stab wound victim – any ED and Trauma doc I know will have fluids, blood, and the needle (and the OR) in hand upon patient arrival. What if a cardiac arrest patient had no cardiac activity? I know Im preaching to the choir here, but spread the word…. the more we talk about it, the pressure builds and change happens…

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