ULTRASOUND
Benefits for patient retrieval services
DR JON MCCORMACK provides an insight into how point of care (PoC) ultrasound systems are proving beneficial to adult and paediatric retrievals services in Scotland, helping pre-hospital care and secondary retrievals from remote sites, as well as aiding routine anaesthesia practice in hospital theatres.
Specialist Transport and Retrieval, ScotSTAR, is a national service covering the whole of Scotland from as far north as the Shetland Islands, down to Stranraer in the south. For adults, the Emergency Retrieval Service trauma team provides roadside stabilisation following accidents, pre-hospital care and secondary retrievals from remote sites, transporting patients requiring a critical level of care that cannot be provided locally to the nearest Intensive Care Unit (ICU). The Paediatric Retrieval Team complements this service, transferring critically ill and injured children from remote and rural areas to the Paediatric Intensive Care Units in Glasgow and Edinburgh. PoC ultrasound systems are vital to these services, enabling pre-hospital assessment of cardiac function, diagnosis of pneumothoraces and faster, more accurate line placement.
Easier triage of trauma cases Due to the geography and remoteness of some areas of Scotland, patient transfers can involve a round trip of as much as 700 miles, and aeromedical transfers using the Scottish Ambulance Service’s dedicated, funded helicopters and planes, equipped with PoC ultrasound systems, play an important role in both paediatric and adult retrievals. The Emergency Retrieval Service
trauma team frequently faces situations where rapid decision making is vital to a successful outcome, depending on PoC ultrasound systems to perform pre-hospital echocardiographs or chest examinations prior to transfer to an ICU. These ultrasound examinations make patient triage easier and help guide when to instigate further interventions, as well as how – and where – to transfer a patient. Faced with a patient in peri-arrest, for example, following a traumatic injury such as a stabbing, having the capability to assess cardiac filling in the field is invaluable to know whether interventions such as pre-hospital blood transfusion or thoracotomy are necessary immediately; pre-hospital blood
Ultrasound examinations make patient triage easier and help guide when to instigate further interventions, as well as how – and where – to transfer a patient.
APRIL 2015
transfusions are a logistical challenge, while performing surgical procedures in suboptimal conditions is clearly best avoided if there is time.
Similarly, in cases of hypothermia or
drowning, echographic analysis can be used to establish that there is still some heart function. Aggressive resuscitation techniques can then be initiated, and the patient transferred to a tertiary hospital with a cardiac centre, rather than a district general hospital offering routine intensive care.
A significant number of adult trauma cases involve road traffic collisions, and the ability to perform an ultrasound examination at the scene is crucial, as motorists often suffer chest injuries caused by an impact with the vehicle’s steering wheel, resulting in a pneumothorax. Although in some cases – such as a patient with a flail chest and in respiratory distress – it is obvious that a chest drain is required, the situation is not always so clear. Accurate diagnosis is vital, particularly when a patient is to be transferred by air,
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