Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study
Abstract Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-06-01
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| Series: | The Ultrasound Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13089-022-00270-w |
| _version_ | 1811343650231156736 |
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| author | Zachary E. Dewar Stephanie Ko Cameron Rogers Alexis Oropallo Andrew Augustine Ankitha Pamula Christopher L. Berry |
| author_facet | Zachary E. Dewar Stephanie Ko Cameron Rogers Alexis Oropallo Andrew Augustine Ankitha Pamula Christopher L. Berry |
| author_sort | Zachary E. Dewar |
| collection | DOAJ |
| description | Abstract Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries. |
| first_indexed | 2024-04-13T19:32:38Z |
| format | Article |
| id | doaj.art-baa4aaa85c2749889c998764a22e70e7 |
| institution | Directory Open Access Journal |
| issn | 2524-8987 |
| language | English |
| last_indexed | 2024-04-13T19:32:38Z |
| publishDate | 2022-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Ultrasound Journal |
| spelling | doaj.art-baa4aaa85c2749889c998764a22e70e72022-12-22T02:33:08ZengSpringerOpenThe Ultrasound Journal2524-89872022-06-011411610.1186/s13089-022-00270-wPrehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational studyZachary E. Dewar0Stephanie Ko1Cameron Rogers2Alexis Oropallo3Andrew Augustine4Ankitha Pamula5Christopher L. Berry6Department of Emergency Medicine, Guthrie Robert Packer HospitalDepartment of Emergency Medicine, Guthrie Robert Packer HospitalGreater Valley EMSDepartment of Emergency Medicine, Guthrie Robert Packer HospitalDepartment of Emergency Medicine, Guthrie Robert Packer HospitalDepartment of Emergency Medicine, Guthrie Robert Packer HospitalDepartment of Emergency Medicine, Guthrie Robert Packer HospitalAbstract Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries.https://doi.org/10.1186/s13089-022-00270-wPneumothoraxTension pneumothoraxEmergency medical servicesPoint-of-care ultrasoundTraumaNeedle decompression |
| spellingShingle | Zachary E. Dewar Stephanie Ko Cameron Rogers Alexis Oropallo Andrew Augustine Ankitha Pamula Christopher L. Berry Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study The Ultrasound Journal Pneumothorax Tension pneumothorax Emergency medical services Point-of-care ultrasound Trauma Needle decompression |
| title | Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study |
| title_full | Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study |
| title_fullStr | Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study |
| title_full_unstemmed | Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study |
| title_short | Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study |
| title_sort | prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy a pilot educational study |
| topic | Pneumothorax Tension pneumothorax Emergency medical services Point-of-care ultrasound Trauma Needle decompression |
| url | https://doi.org/10.1186/s13089-022-00270-w |
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