Point-of-care ultrasound (POCUS) use in mountain emergency medicine: results from an international online survey.

backgroundThe extent to which point-of-care ultrasound (POCUS) is currently being used in international mountain emergency medicine has not yet been investigated. The aim of this study was to determine the use of POCUS in mountain rescue organizations which are members of the International Commission for Alpine Rescue (ICAR).

methodsWe asked 92 ICAR member organizations to complete an online survey to gather information about staffing, ultrasound equipment, indications, perceived utility, and aspects of education and clinical supervision.

resultsOur survey had a response rate of 42% (n = 39). The availability of POCUS in rescue organizations was associated with the type of staffing and rescue provided. Organizations with POCUS (31%, n = 12) were permanently (67%, n = 8; 95%-CI: 35–90%) or intermittently (33%, n = 4; 95%-CI: 10–65%) staffed by physicians (p = 0.006). POCUS was mostly available in organizations with professional staff (58%, n = 7; 95%-CI: 28–85%). In contrast, organizations with voluntary staff mostly did not use POCUS (70%, n = 19; 95%-CI: 50–86%) (p = 0.002). Organizations with POCUS mostly provided a combination of both HEMS and terrestrial rescue (75%, n = 9; 95%-CI: 43–95%), whereas organizations without POCUS (69%, n = 27) mostly provided terrestrial rescue alone (70%, n = 19; 95%-CI: 50–86%) (p = 0.001). Most organizations (67%, n = 8) used POCUS in < 10% of their treated patients. In these select patients, however, POCUS was perceived to change on-site treatment and improve patient outcomes. POCUS was considered equally relevant in both medical and traumatic emergencies. Half of the providers used standardized ultrasound protocols (50%, n = 6). Half of the rescue organizations did not record POCUS findings (50%, n = 6). Most rescue organizations did not have a framework in place for education and clinical supervision (91%, n = 10).

conclusionsOur survey shows that POCUS plays a considerable role in international mountain emergency medicine. POCUS is primarily used by physicians in HEMS but is also available in organizations who provide terrestrial rescue. Most rescue providers use POCUS in select patient groups, with perceived benefits on clinical decision-making and patient outcomes. Although providers often use standardized protocols when performing examinations, aspects of education and clinical supervision will need to be addressed in the future.