CHALLENGES OF IMPLEMENTATION OF A FAST-TRACKED PRE-HOSPITAL POCUS ROUTINE
Abstract
The COVID-19 pandemic has changed the way of care for our patients and for our staff, many departments have compared the pandemic period to a 4 yearlong mass casualty situation managing scarce resources with insufficient manpower in a constantly shifting environment. A major bottleneck for healthcare systems were imagistic studies and the constant need for it, a foundation of modern medical practice. With the aim to improve care and facilitate better decision making we introduced a portable ultrasound device to the pre-hospital team, after providing Point of Care Ultrasound workshops to practicing physicians. Materials and methods: We performed a prospective observational study over 6 months, during the height of the COVID pandemic, using the extended Focused Assessment Sonography in Trauma (eFAST) protocol and the Shock Index (SI) to understand patient status; voluntary sampling was done by emergency physicians. The final outcomes were patient numbers, severity and type of cases and usage trends. Results: the study registered 34 patients: 41% traumas, 35% cardiac arrests, 18% shock, 6% acute respiratory distress. Conclusions: The overall increase and necessity of POCUS use during the pandemic or other mass casualty incidents does not equate to competency or familiarity of use despite workshops, instruments and willingness. Adapting and improving implementation of any new techniques requires a mature and professional team willing to collaborate, establish transparent feedback loops and implementation programs catered to the local needs. In this article we discuss the benefits and flaws we identified from a direct approach.
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