Page 81 - Journal of Special Operations Medicine - Spring 2015

Operational Point-of-Care Ultrasound Review:
Low-Cost Simulators and Resources for
Advanced Prehospital Providers

Elliot M. Ross, MD; Travis Deaton, MD; Nicole Hurst, MD; John Siefert, MD

ABSTRACT

Prehospital ultrasound use is a relatively new skill set. The military noted the clear advantages of this skill set
The military noted the clear advantages of this skill set in the deployed setting and moved forward with teach­
in the deployed setting and moved forward with teach­ ing advanced Combat trauma medics skills to perform
ing their advanced combat trauma medics skills to per­ specific examinations. One group within the Special
form specific examinations. The training curriculum for Operations Forces (SOF) community focused on the
Special Operations­level clinical ultrasound was created initial process for training SOM to use point­of­care
and adapted from training guidelines set forth by the ultrasound (POCUS). This group created the training
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American College of Emergency Physicians with a focus curriculum for Special Operations–level clinical ultra­
on the examinations relevant to the Special Operations sound (SOLCUS) and adapted current training guide­
community. Once providers leave the training environ­ lines set forth by the American College of Emergency
ment, skill sustainment can be difficult. We discuss the Physicians to the examinations relevant to the SOM
relevant ultrasound exams for the prehospital setting. community. A few experienced medics were selected to
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We address opportunities to improve point­of­care ul­ be ultrasound champions and received training by senior
trasound skills through hands­on experience while in medical officers who were proficient in ultrasound use.
a fixed medical facility. Options for simulation­based These medics received extra training both at the unit
training are discussed with descriptions for creating low­ level and by attending multiple national POCUS train­
cost simulation models. Finally, a list of online resources ing courses. In turn, these ultrasound champion medics
is provided to review specific ultrasound examinations. returned to their units and trained other unit medics.
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The same group of authors then reviewed the quality
Keywords: point-of-care ultrasound, prehospital ultrasound, of images of examinations performed during a unit de­
Special Operations–level clinical ultrasound, simulation ployment and evaluated how POCUS was used in the
deployed setting. Their findings suggested that the qual­
ity of ultrasounds performed by the medics was high.
Introduction
The following examinations were used most commonly:
Prehospital ultrasound use is a relatively new and emerg­ musculoskeletal examinations to evaluate long­bone
ing concept. A growing body of literature has examined fractures, trauma examinations to include the extended­
the utility of ultrasound in the hands of highly qualified focused assessment with sonography in trauma (eFAST),
physicians and advanced trauma nursing personnel in superficial evaluations for abscess discrimination and
the prehospital setting. 1–4 The majority of this research foreign bodies, procedural guidance for intravenous
is from European­modeled emergency medical services (IV) access, regional anesthesia, evaluation of fetal heart
(EMS), where physicians and nurses with advanced train­ rate in pregnancy, and evaluation of ocular injuries. 6
ing remain the primary prehospital medical responders. 3
Initial medical training for SOM usually includes some
The case for the use of ultrasound by prehospital provid­ basic ultrasound experience in the schoolhouse setting.
ers and Special Operations medics (SOM) has already The SOLCUS training is designed to provide the ini­
been made by multiple authors. 2,5–15 A recent review in tial introduction to ultrasound concepts and examina­
2012 looked at ultrasound skills performed by military tions and is now being offered during the initial training
medical technicians and demonstrated that they can re­ process.
liably and accurately complete the examinations, but
found clear lack of standardization of the initial cur­ While these efforts have improved the initial training
riculum and sustainment of training. 9 process in POCUS, responsibility for maintenance of

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