Emergency ultrasound: A prospective study on sufficient adequate training for military doctors - 09/11/13

Doi : 10.1016/j.diii.2013.04.016

N. Cazes ^a,^⁎ , F. Desmots ^b, Y. Geffroy ^b, A. Renard ^a, J. Leyral ^c, K. Chaumoître ^d
^a Emergency Department, Laveran Army Training Hospital, 34, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
^b Radiology and medical imaging department, Laveran Army Training Hospital, 34, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
^c Emergency Department, Bégin Army Training Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
^d Radiology and medical imaging department, hôpital Nord University Hospital Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France

^⁎Corresponding author.

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Abstract

Purpose

To evaluate the feasibility of “accelerated” training for military doctors in front line ultrasound. To establish the number of ultrasounds required to validate the doctor's training. To assess the average acquisition time for each ultrasound target.

Materials and methods

Prospective study on 10 novice generalist military doctors to assess training for five urgent ultrasound targets: focused assessment with sonography in trauma (FAST), pleura, bladder, abdominal aorta and gallbladder. Each student received theoretical and practical training on “healthy” people and then performed 10 timed ultrasounds in an emergency situation, the result of which was either confirmed or rejected by a nationally qualified ultrasound expert.

Results

Some targets were easier to acquire (bladder, aorta and pleura) with excellent diagnostic performance after 10 ultrasounds on healthy people (sensitivity=100%; specificity=100%). The overall number of ultrasound errors fell over time. The median investigation time also fell significantly for all targets, reaching a plateau. Twenty ultrasounds including 10 “real life” appear to be needed for FAST. A minimum number of 30 ultrasounds is required to diagnose acute cholecystitis.

Conclusion

“Accelerated” training for generalist military doctors in front line ultrasound is achievable. The recommended number of 25 ultrasounds per target is not appropriate for all ultrasound targets.

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Keywords : Ultrasound, Training, Military doctor, Front line medicine, Emergency