ORIGINAL ARTICLES
IMAJ | volume 24
Journal 9, September 2022
pages: 596-601
A randomized, controlled, blinded evaluation of augmenting point-of-care ultrasound and remote telementored ultrasound in inexperienced operators
- Jacob Chen,
- Alex Dobron,
- Akiva Esterson,
- Lior Fuchs,
- Elon Glassberg,
- David Hoppenstein,
- Regina Kalandarev-Wilson,
- Itamar Netzer,
- Mor Nissan,
- Rachelly Shifer Ovsiovich,
- Raphael Strugo,
- Oren Wacht,
- Chad Ball,
- Naisan Garraway ,
- Lawrence Gillman,
- Andrew Kirkpatrick,
- Volker Kock,
- Paul McBeth,
- Jessica McKee,
- Juan Wachs,
- Scott d’Amours
1Hospital Management, Meir Medical Center, Kfar Saba, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3Israeli Defense Force Medical Corp, Jerusalem, Israel
4Department of Emergency Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
5Intensive Care Unit, Soroka University Medical Center, Beer Sheva, Israel
6Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
7Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
8Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
9Magen David Adom EMS, Or Yehuda, Israel
10Regional Trauma Services, and the Department of Surgery, University of Calgary, Calgary, Alberta, Canada
11Foothills Medical Centre, Calgary, Alberta, Canada
12University of British Columbia, Vancouver, British Columbia, Canada
13Vancouver General Hospital, Vancouver, British Columbia, Canada
14Canadian Forces, Winnipeg, Manitoba, Canada
15University of Manitoba, Winnipeg, Manitoba, Canada
16TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta
17School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
18University of New South Wales, Sydney, Australia
19Trauma and Acute Care Surgery, Liverpool Hospital, Sydney, Australia
20Clalit Health Services, Jerusalem, Israel
21Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
Summary
Background:
Handheld ultrasound devices present an opportunity for prehospital sonographic assessment of trauma, even in the hands of novice operators commonly found in military, maritime, or other austere environments. However, the reliability of such point-of-care ultrasound (POCUS) examinations by novices is rightly questioned. A common strategy being examined to mitigate this reliability gap is remote mentoring by an expert.
Objectives:
To assess the feasibility of utilizing POCUS in the hands of novice military or civilian emergency medicine service (EMS) providers, with and without the use of telementoring. To assess the mitigating or exacerbating effect telementoring may have on operator stress.
Methods:
Thirty-seven inexperienced physicians and EMTs serving as first responders in military or civilian EMS were randomized to receive or not receive telementoring during three POCUS trials: live model, Simbionix trainer, and jugular phantom. Salivary cortisol was obtained before and after the trial. Heart rate variability monitoring was performed throughout the trial.
Results:
There were no significant differences in clinical performance between the two groups. Iatrogenic complications of jugular venous catheterization were reduced by 26% in the telementored group (
P < 0.001). Salivary cortisol levels dropped by 39% (
P < 0.001) in the telementored group. Heart rate variability data also suggested mitigation of stress.
Conclusions:
Telementoring of POCUS tasks was not found to improve performance by novices, but findings suggest that it may mitigate caregiver stress.