Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis

Abstract Background Auscultating for breath sounds to assess for pneumothorax in the helicopter emergency medical services (HEMS) settings can be extremely challenging. Thoracic point of care ultrasound (POCUS) offers a seemingly more useful visual (rather than audible) alternative. This review critically and quantitatively evaluates the use of thoracic POCUS for pneumothorax in the HEMS setting. Methods A systematic literature review with meta-analysis was conducted. Only papers reporting on patients undergoing POCUS for pneumothorax in the helicopter or pre-hospital setting were included. Primary outcome was accuracy, focusing on sensitivity and specificity. Secondary outcome was practicality. PubMed, Embase and the Cochrane Library were searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess validity of studies. Results Twelve studies reporting on n = 1,936 images from medical and trauma patients were included in qualitative synthesis. Studies were nearly all observational designs. Most images were acquired by nurses or paramedics who were previously novices to ultrasound. The reference standard was predominantly CT. Specificity results were unanimously precise and very high, whereas sensitivity results were imprecise and extremely variable. Meta-analysis of eight studies involving n = 1,713 images yielded pooled sensitivity 61% (95% CI: 27–87%; I2 = 94%) and pooled specificity 99% (95% CI: 98–100%; I2 = 89%). Six studies involving n = 315 images reported practicality. The highest or second highest categorisation of image quality was reported in around half of those images. Conclusion Thoracic POCUS is highly specific but has extremely variable sensitivity for pneumothorax when performed in the HEMS setting. This is from purely a diagnostic (not clinical) perspective. Sensitivity increases when only clinically significant pneumothoraces are considered. Case reports reveal thoracic POCUS can appropriately alter treatment and triage decisions, but only for a small number of patients. It appears predominantly useful in mitigating against unnecessary interventions. More research reporting patient focused outcomes is required. In the meantime, thoracic POCUS appears to offer a more appropriate visual alternative to auscultation for breath sounds when assessing for pneumothorax in the HEMS setting.

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HEMS dispatch: A systematic review

Trauma ◽

10.1177/1460408617721565 ◽

2017 ◽

Vol 20 (1) ◽

pp. 3-10 ◽

Cited By ~ 5

Author(s):

Georgette Eaton ◽

Simon Brown ◽

James Raitt

Keyword(s):

Systematic Review ◽

Emergency Medical Services ◽

Meta Analysis ◽

Medical Services ◽

Cochrane Library ◽

Physiological Data ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

The Cochrane Library ◽

Injured Patients

Introduction Helicopter emergency medical services dispatch is a contentious issue in modern prehospital services. Whilst the link between helicopter emergency medical services and improved patient outcome is well evidenced, allocation to the most appropriate incidents remains problematic. It is unclear which model of deployment is the most efficient at targeting major trauma and whether this can be improved with a change in dispatch process. The objective of this study was to have an overview of the evidence for dispatch models of helicopter emergency medical services to critically ill or injured patients. Methods This systematic review was conducted in accordance with a protocol developed from the PRISMA guidelines. MEDLINE, Embase, CINAHL and the Cochrane library were searched focusing on keywords involving dispatch of helicopter emergency medical services resources. Results Ninety-seven articles were screened and 14 articles were eligible for inclusion. Most were of low quality, with three of moderate quality. Heterogeneity in the methodology of included articles precluded meta-analysis, so a narrative review was performed. Conclusions This review demonstrates the lack of evidence surrounding helicopter emergency medical services dispatch models. Whilst it is not possible to identify a method of dispatch that will optimize helicopter emergency medical services allocation, common themes within the literature indicate that helicopter emergency medical services use is region specific and dispatch criteria should be designed to match specific systems. Additionally, mechanism of injury as well as physiological data from scene was shown to be the most accurate indicator for helicopter emergency medical services attendance.

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Determining a Need for Point-of-Care Ultrasound in Helicopter Emergency Medical Services Transport

Air Medical Journal ◽

10.1016/j.amj.2021.01.003 ◽

2021 ◽

Author(s):

Timothy J. Lenz ◽

Mary Beth Phelan ◽

Tom Grawey

Keyword(s):

Emergency Medical Services ◽

Point Of Care ◽

Medical Services ◽

Point Of Care Ultrasound ◽

Helicopter Emergency Medical Services ◽

Emergency Medical

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Prehospital Evaluation of Effusion, Pneumothorax, & Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services

Western Journal of Emergency Medicine ◽

10.5811/westjem.2015.5.25414 ◽

2015 ◽

Vol 16 (4) ◽

pp. 503-509 ◽

Cited By ~ 11

Author(s):

Sundeep Bhat ◽

David Johnson ◽

Jessica Pierog ◽

Brita Zaia ◽

Sarah Williams ◽

...

Keyword(s):

Emergency Medical Services ◽

Point Of Care ◽

Medical Services ◽

Point Of Care Ultrasound ◽

Emergency Medical

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Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽

10.1136/bmjopen-2020-043791 ◽

2021 ◽

Vol 11 (1) ◽

pp. e043791

Author(s):

Jan Bauer ◽

Dieter Moormann ◽

Reinhard Strametz ◽

David A Groneberg

Keyword(s):

Cost Effectiveness ◽

Emergency Medical Services ◽

Rural Areas ◽

Medical Services ◽

Secondary Outcome ◽

Annual Average ◽

Emergency Medical ◽

Life Years ◽

Timely Access ◽

The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

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