Ultrasound applied to nursing in the Emergency Medical Service (EMS): a scoping review

From Firenze University Press Journal: Infermieristica Journal

Enrico Lucenti, RN, Emergency Nurse Specialist, Department of Pre-Hospital Emergency, Piacenza Hospital; Adjunct professor, Nursing School of Piacenza, University of Parma

Lucrezia Lavelli, RN, Casa di Cura Piacenza

Walter De Luca, RN, Emergency Nurse Specialist, Emergency Medical Service, Ravenna Hospital

Maurizio Beretta, RN, Nursing School of Piacenza University of Parma-Piacenza Hospital; Piacenza Nursing Council Board Member

In recent years ultrasound has represented a new field of application for nursing. The non-invasive approach, the repeatability and the low cost have allowed a rapid diffusion mainly and initially in the intra-hospital environment for the Point-of-care ultrasound (POCUS), the intravenous catheters’ insertion and the assessment of bladder and fluid status, while, again at the healthcare level, ultrasound has only recently begun to take its first steps in the Emergency Medical Service (EMS). POCUS has been de!ned as one of the skills on which to mainly invest in research and training in the pre-hospital setting.

“The Emergency Medical Service’s nurses are professional whom, in possession of the requirements of current legislation, serves in the rescue team independently or in collaboration with other health professionals, members of the same team; implements interventions aimed at maintaining, restoring and supporting vital functions and provides health care using nursing intervention procedures and algorithms, guaranteeing their correct application to the patient”. EMS nurses must be trained and able to implement advanced interventions on the patients’ rescue aimed at restoring and maintaining their vital functions.

In pre-hospital setting, in the delicate and o$en complex management of severely ill patients, there is the possibility of assessing patients using ultrasound techniques to better understand their signs and symptoms.The literature in the EMS setting regarding ultrasound performed by nurses, is today very poor, so it is necessary to investigate in-hospital studies to have a start point. A 2010 study comparing the results obtained from the performance of different ultrasound techniques used by nurses working in Emergency Departments (ED) and physicians working in the same area showed that “nurse practitioners” can perform a focused ultrasound examination with a high degree of accuracy.

The same accuracy in ED is found in the implementation of the Extended Focused Assessment with Sonography in Trauma (E-FAST) by nurses when compared with the medical sta#. The care to the patient in the pre-hospital setting consists in the assessment and treatment aimed at resolving the condition that put the patient in imminent danger of life, then a continuous observation of the clinic for any new interventions or action changes. The ultrasound aid allows the healthcare professionals to increase the quality of the assistance provided, also impacting the healthcare system, reducing its costs. Some literature reviews stressed the importance of ultrasound in the assessment of patient in the pre-hospital setting , even if it is considered necessary to deepen the topic regarding the efficacy of assessment by ultrasound analyzing the outcome of rescued patient.

Despite EMS nurse-led sonography is poorly analyzed, there are more studies involving the execution of ultrasound scans by technical personnel (Emergency Medical technicians — EMT) or paramedics, as dedicated training courses already exist in other countries. A pilot study states that, with close supervision, paramedics can correctly obtain and interpret the Focused Assessment with Sonography in Trauma (FAST) and abdominal aortic ultrasound exams. Additionally, technical and paramedical sta#perform chest ultrasound scans with adequate and sufficient image quality to determine whether or not pathology is present. Even in the case of cardio-circulatory arrest, EMTs perform a correct cardiac ultrasound to evaluate the contractile activity of the heart.

DOI: https://doi.org/10.36253/if-1641

Read Full Text: https://riviste.fupress.net/index.php/if/article/view/1641