Beginning nearly three years ago, Survival Flight, the University of Michigan’s medical transport programs flight nursing staff, embarked on a journey to provide point of care ultrasound for patients during transport.

Since designing and implementing their program, they have increased their knowledge base, usage, skill sets and education in relation to Point of Care Ultrasound. Their team recently presented a paper at the American College of Emergency Physicians’ meeting regarding the educational aspect of their training, and recently submitted a scientific paper for review and possible inclusion in the AirMed Journal. Their team is also presenting at the SAEM conference in Las Vegas in May of 2019.

But how did they get started down their journey to POCUS?

Read more to learn about how they began.

At the beginning of October 2015, Survival Flight, the University of Michigan’s medical transport programs flight nursing staff, embarked on a journey to acquire the basic skills necessary to provide point of service ultrasound for patients during transport. 

Point of Care Ultrasound (POCUS) has been in clinical use for a decade or more in the Emergency Services setting. Initially confined to use by Physicians and certified Ultra-sonographers, its applications have expanded along with the numbers of healthcare providers who utilize it.

Currently, POC Ultrasound is used in both community and academic hospital settings as well as the prehospital setting for diagnosing acute life-threatening conditions and as a guide for invasive procedures. These procedures are performed and interpreted by emergency physicians or those who are under the supervision of emergency physicians whether in a hospital or in a pre-hospital setting.

As an emergency procedure, POC ultrasound is goal-directed and answers clinical questions pertinent to emergency management of critically ill or injured patients and should be viewed as complimentary to the physical examination.

As stated in the ACEP Emergency Ultrasound Guidelines policy statement, “there is increasing evidence that ultrasound has a legitimate role in out of hospital emergency care.” A team at the University of Michigan lead by Dr. Ross Kessler and Paul Mazurek (Education Nurse Coordinator) began to develop a program with the understanding that there were significant challenges to the implementation of an out of hospital ultrasound program regarding the training and equipment as well as careful physician oversite and quality assurance.

In early 2015 preliminary meetings took place to discuss teaching the Flight Nurses POC ultrasound. It was decided that the FN’s would be ideal candidates to teach POCUS given the patient population that SF transported.
Survival Flight Nurses were to be trained in POC ultrasound with the driving concept that it would be utilized for a well-defined purpose that is linked to improving patient outcomes. Equally was the idea that the exams could be easily learned and performed and that the findings would be easily recognizable and could be done at the bedside.

Conversations about developing the program focused on identifying the settings and patients where the benefit to the patient would justify purchasing the equipment and investing in the training.
Meetings took place and the conclusions were that there would be a required pathway to competency and would include didactics, hands on training and a competency check off with a senior physician skilled in POC ultrasound.
At the beginning of October 2015, Survival Flight, the University of Michigan’s medical transport programs flight nursing staff, embarked on a journey to acquire the basic skills necessary to provide point of service ultrasound for patients during transport.

Initial training consisted of 6 foundational didactic sessions each lasting 2 hours. Covered in these lectures were basic “knobology” and probe handling of the FUJIFILM SonoSite IViz machines as well as anatomy as viewed in the ultrasound windows including an introduction to the basic views of the heart, lungs, liver and kidneys using the SonoSite machines.

Additionally, asynchronous lectures were posted in the Survival Flight education folder on line for viewing by the flight nurses prior to each lecture. Concurrent with the lectures were “hands-on” portions where the flight nurses applied learned skills using human models for practice repetitions of the different ultrasound studies (FAST, RUSH, Cardiac, IVC, lung). Parallel to the training sessions, the flight nurses were provided with an array of web-based training, human patient simulators and direct patient contact for practice.

The flight nurses were required to perform a minimum of 10 ultrasounds on live patients for each of the studies. These were documented with an on-line tracking system that included general information on the patient and a description of the specific views obtained. In turn, these practice sessions were recorded and reviewed by a senior staff emergency physician or one of the designated ultrasound fellows or senior emergency medicine residents.
Sample cases were presented during the Survival Flight grand rounds weekly meetings, where ultrasound could have been utilized in caring for the patient.

At the end of a set period of time, an Objective Structured Clinical Examination (OSCE) was given to each of the flight nurses by Dr. Kessler or his designee as a final check-off prior to use in the field.

Finally, there was a small group of “super-users” among the flight nursing staff that were identified as being ardent enthusiasts of ultrasound to assist in teaching and skills maintenance for the remainder of the flight nurses.

To date, every nurse has been signed off and approved to carry and use the portable ultrasound on transport. From early detection to confirmation of suspicions for abnormalities or disease states, the ultrasound has provided our team with a new tool in the care of our patients.

Editor's Note: Stay tuned to future editions of the ACCT Advocate when we will update Survival Flight's progress and published research.


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