Background: Ultrasound (US) examination has many uses in resuscitation, but to use it to its full effectiveness typically requires a trained and proficient user. We sought to use information technology advances to remotely guide US-naive examiners (UNEs) using a portable battery-powered tele-US system mentored using either a smartphone or laptop computer. Materials and Methods: A cohort of UNEs (5 tactical emergency medicine technicians, 10 ski-patrollers, and 4 nurses) was guided to perform partial or complete Extended Focused Assessment with Sonography of Trauma (EFAST) examinations on both a healthy volunteer and on a US phantom, while being mentored by a remote examiner who viewed the US images over either an iPhone((R)) (Apple, Cupertino, CA) or a laptop computer with an inlaid depiction of the US probe and the patient, derived from a videocamera mounted on the UNE's head. Examinations were recorded as still images and over-read from a Web site by seven expert reviewers (ERs) (three surgeons, two emergentologists, and two radiologists). Examination goals were to identify lung sliding (LS) documented by color power Doppler (CPD) in the human and to identify intraperitoneal (IP) fluid in the phantom. Results: All UNEs were successfully mentored to easily and clearly identify both LS (19 determinations) and IP fluid (14 determinations), as assessed in real time by the remote mentor. ERs confirmed IP fluid in 95 of 98 determinations (97%), with 100% of ERs perceiving clinical utility for the abdominal Focused Assessment with Sonography of Trauma. Based on single still CPD images, 70% of ERs agreed on the presence or absence of LS. In 16 out of 19 cases, over 70% of the ERs felt the EFAST exam was clinically useful. Conclusions: UNEs can confidently be guided to obtain critical findings using simple information technology resources, based on the receiving/transmitting device found in most trauma surgeons' pocket or briefcase. Global US mentoring requires only Internet connectivity and initiative.
Bibliographical noteThe Kyoto Kagaku Company (Kyoto, Japan) and the Sonosite Corporation (Bothell, WA) provided unrestricted use of a FAST/ER FAN ultrasonographic simulator and a NannoMaxx ultrasonographic unit, respectively, for research purposes. Michelle Mercado and Alma Radosfor are thanked for Web hosting, and Jessica McKee is thanked for review of the manuscript. Kevin Champagne, Martin Spriggs, Tim
Bantle, Karen Janz, the Ski-Patrol of Sunshine Mountain, and the City of Calgary tactical emergency medical technicians are thanked for research assistance.
- remote medicine
- prehospital care
- Level V: hypothesis-generating study