Portable ultrasound for remote environments, Part I: Feasibility of field deployment.

BACKGROUND In field medical operations, rapid diagnosis and triage of seriously injured patients is critical. With significant bulk and cost constraints placed on all equipment, it is important that any medical devices deployed in the field demonstrate high utility, durability, and ease of use. When medical ultrasound was first used in patient care, machine cost, bulk, and steep learning curves prevented use outside of the radiology department. Now, lightweight portable ultrasound is widely employed at the bedside by emergency physicians. The techniques and equipment have recently been extrapolated out of the hospital setting in a wide variety of environments in an effort to increase diagnostic accuracy in the field. OBJECTIVES In this review, deployment of lightweight portable ultrasound in the field (by emergency medical services, military operations, disaster relief, medical missions, and expeditions to austere environments) is examined. The feasibility of field deployment and experiences of clinicians using ultrasound in a host of environments are detailed. In addition, special technological considerations such as telemedicine and machine characteristics are reviewed. CONCLUSIONS The use of lightweight portable ultrasound shows great promise in augmenting clinical assessment for field medical operations. Although the feasibility of the technology has been demonstrated in certain medical and trauma applications, further research is needed to determine the utility of ultrasound use for medical illness in the field.

[1]  A. Lumsden,et al.  A prospective study of a hand-held ultrasound device in abdominal aortic aneurysm evaluation. , 2003, American journal of surgery.

[2]  J. Montilla,et al.  Radiology in a hostile environment: experience in Afghanistan. , 2006, Military medicine.

[3]  Andrew W Kirkpatrick,et al.  Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma. , 2005, Canadian journal of surgery. Journal canadien de chirurgie.

[4]  A. Sargsyan,et al.  Evaluation of shoulder integrity in space: first report of musculoskeletal US on the International Space Station. , 2005, Radiology.

[5]  M. Busch Portable ultrasound in pre‐hospital emergencies: a feasibility study , 2006, Acta anaesthesiologica Scandinavica.

[6]  A J Brooks,et al.  FAST on operational military deployment , 2005, Emergency Medicine Journal.

[7]  D. R. Brown,et al.  Digital hand-held sonography utilised for the focused assessment with sonography for trauma: a pilot study. , 2001, Annals of the Academy of Medicine, Singapore.

[8]  J J Bax,et al.  Abdominal aortic aneurysm screening using a hand-held ultrasound device. "A pilot study". , 2001, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[9]  S. B. Jones,et al.  Ultrasonography in a forward-deployed military hospital. , 2005, Military medicine.

[10]  M. Blaivas,et al.  A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. , 2005, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[11]  Shannon Melton,et al.  Ocular examination for trauma; clinical ultrasound aboard the International Space Station , 2005 .

[12]  V. Noble,et al.  Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. , 2007, Chest.

[13]  K B Laupland,et al.  Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). , 2004, The Journal of trauma.

[14]  R. Adler,et al.  Utility of Portable Ultrasound in a Community in Ghana , 2008, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[15]  T. Bauch,et al.  Feasibility of remote echocardiography with satellite transmission and real-time interpretation to support medical activities in the austere medical environment. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[16]  J. Clinton,et al.  Ultrasound for the air medical clinician. , 2004, Air medical journal.

[17]  J. De Sutter,et al.  Experience with an ultrasound stethoscope. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[18]  D. Nelson,et al.  Emergency echocardiography telemedicine: an efficient method to provide 24-hour consultative echocardiography. , 1996, Journal of the American College of Cardiology.

[19]  David Adler,et al.  Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania , 2008, International journal of emergency medicine.

[20]  U. Schweigkofler,et al.  Prehospital ultrasound imaging improves management of abdominal trauma , 2006, The British journal of surgery.

[21]  J. Berger,et al.  Ultrasonography as an aid to diagnosis and treatment in a rural African hospital: a prospective study of 1,119 cases. , 1999, The American journal of tropical medicine and hygiene.

[22]  Robert T Gerhardt,et al.  Satellite and mobile wireless transmission of focused assessment with sonography in trauma. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[23]  Juin-Jet Hwang,et al.  Portable ultrasound device for battlefield trauma , 1998, 1998 IEEE Ultrasonics Symposium. Proceedings (Cat. No. 98CH36102).

[24]  V. Noble,et al.  Development of an ultrasound training curriculum in a limited resource international setting: successes and challenges of ultrasound training in rural Rwanda , 2008, International journal of emergency medicine.

[25]  William H Moore,et al.  History of Emergency Ultrasound , 2004, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[26]  Approved October,et al.  Emergency ultrasound guidelines. , 2009, Annals of emergency medicine.

[27]  Mei-Ju Su,et al.  Application of tele-ultrasound in emergency medical services. , 2008, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[28]  M. Blaivas,et al.  Change in Differential Diagnosis and Patient Management With the Use of Portable Ultrasound in a Remote Setting , 2005, Wilderness & environmental medicine.

[29]  B. Hu,et al.  Rapid assessment of cardiac anatomy and function with a new hand-carried ultrasound device (OptiGo): a comparison with standard echocardiography. , 2001, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[30]  Shannon Melton,et al.  FAST at MACH 20: clinical ultrasound aboard the International Space Station. , 2005, The Journal of trauma.

[31]  J. Mcmanus,et al.  Use of Ultrasonography to Avoid an Unnecessary Procedure in the Prehospital Combat Environment: A Case Report , 2006, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[32]  M. Heller,et al.  A EROMEDICAL T RAUMA S ONOGRAPHY BY F LIGHT C REWS WITH A M INIATURE U LTRASOUND U NIT , 2001, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[33]  Palmer Pe Manual of Diagnostic Ultrasound , 1995 .

[34]  V. Noble,et al.  Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008 , 2009, BMC international health and human rights.

[35]  Frédéric Lapostolle,et al.  Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. , 2006, The American journal of emergency medicine.

[36]  Andrew W Kirkpatrick,et al.  The hand-held FAST: experience with hand-held trauma sonography in a level-I urban trauma center. , 2002, Injury.