Disaster Ultrasound

Posted by: Joseph Cuthbertson; 20 June 2016; 12:15 pm

Post written by: Dr. Sanjeev Bhoi, All India Institute of Medical Sciences (AIMMS)

Point of care sonography (POCS) done by clinicians has become popular over the past two decades¹. Its use has been described as an adjunct to physical examination during resuscitation ².Ultrasound has also been shown to be useful to emergency care providers with differing levels of training, background, and clinical focus such as trauma and emergency care ³. The Focused Assessment with Sonography in Trauma (FAST) examination has become the standard of care for the diagnosis of post-traumatic pericardial tamponade and hemoperitoneum ⁴. POCS is also useful in diagnosis of chest, extremity trauma, evaluation of shock states and intravascular volume depletion ^4,5,6,7.

Disasters are situations which demands quick triage of large numbers of injured patients, especially in a resource limited setting ⁸. An immediately deployable, flexible and resource-sparing emergency medical response is key to improve survival during disaster. In disasters, the benefit from early intervention to the injured is often undermined by relative lack of healthcare personnel, a chaotic environment, and deficient stable social infrastructure ^6,7.This limits the availability of most modern diagnostic tools, especially imaging modalities, because they are resource intensive and require a high degree of infrastructural integrity. Thus, in a disaster, responders may be forced to rely only on history and clinical examination which is relatively time-consuming and often inaccurate approach in this setting.

Modern ultrasound machines are portable, robust, easy to use, and inexpensive. These advances allow ultrasound to be brought to the patients to acquire diagnostic information in real time. In addition, literature describes its use in remote, austere, and resource-poor settings, including outer space, high altitudes and combat settings⁹. It can address triage, resuscitation and critical treatment decisions during the disaster ^10,11,12,13. Virtual technology such as telemedicine can be integrated with the POCS to make critical management decisions in the field. These qualities of point of care ultrasound makes it uniquely suited for deployment in the care of patients in the setting of a disaster.
 
References

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2. Brooks A, Davies B, Smethhurst M, Connolly J. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J. 2004;21: e5.
3. Nelson BP, Chason K. Use of ultrasound by emergency medical services: a review. Int J Emerg Med.2008; 1:253–259.
4. 4 Rozycki GS. Surgeon-performed ultrasound: its use in clinical practice. Ann Surg. 1998; 228:16–28.
5. Dulchavsky SA, Henry SE, Moed BR, Diebel LN, Marshburn T, Hamilton DR, et al. Advanced ultrasonic diagnosis of extremity trauma: the FASTER examination. J Trauma.2002;53:28–32.
6. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005; 23:45–50.
7. Ebrahim A, Yousefifard M , Kazemi H , Rasouli H , Asady H , Jafari A Diagnostic Accuracy of Chest Ultrasonography versus Chest  Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos.2014; 13(4): 29–40.
8. Burkle FM Jr. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am.2002; 20:409–436.
9. Ma OJ, Norvell JG, Subramanian S. Ultrasound applications in mass casualties and extreme environments. Crit Care Med. 2007;35: S275–S279.
10. Stawicki SP,Howard JM, Pryor JP, Bahner DP, Whitmill ML, Dean AJ Portable ultrasonography in mass casualty incidents: the caveat examination.World J Orthop 2010 ;1(1):10-9.
11. Blaivas M. Triage in the trauma bay with the focused abdominal sonography for trauma (FAST) examination. J Emerg Med. 2001; 21:41–44.
12. Mazur SM, Rippey J. Transport and use of point-of-care ultrasound by a disaster medical assistance team. Prehosp Disaster Med. 2009; 24:140–144.
13. Wydo SM, Seamon MJ, Melanson SW , Thomas PD, Bahner P, Stawicki SP. Portable ultrasound in disaster triage: a focused review. Eur J Trauma Emerg Surg. 2016 42:151–159.