Table 1.
Prehospital Paramedic-Performed Tele-Ultrasound Study Features
| Article | Study Design and Setting | Objective | Number and Experience Level of Paramedic Sonographers | Number of Patients and Patient Population | US Views Obtained | Outcome Measures | Results |
|---|---|---|---|---|---|---|---|
| Boniface, et al 2011 | Feasibility study, simulated prehospital setting, USA | Assess ability of novice paramedics to perform FAST exam under remote guidance | 51 US-naive paramedics (20-minute US lecture) | 1 healthy volunteer | FAST exam for hemoperitoneum only | Adequacy of images, time to complete examination | 100% success rate of obtaining adequate views and FAST images obtained in less than five minutes |
| Ito, et al 2011 | Feasibility study, simulated prehospital setting, Japan | Evaluate performance of a wearable tele-echography robot within an emergency vehicle | 9 US-naive paramedics | 3 healthy volunteers | FAST exam ◊ | Time to attach robot, image quality | Robot could be attached by paramedic in less than five minutes, images were of sufficient quality |
| Ito, et al 2012 | Feasibility study, simulated prehospital setting, Japan | Evaluate performance of a wearable tele-echography robot within an emergency vehicle | 9 US-naive paramedics | 3 healthy volunteers | FAST exam ◊ | Time to attach robot, time to complete FAST exam | Robot could be attached by paramedic in less than five minutes, FAST scan completed by remote physician in nine minutes, suitable for FAST and emergency medical care |
| McBeth, et al 2013 | Feasibility study, Canada | Evaluate ability of US-naive examiners to identify lung sliding and intraperitoneal fluid with remote mentoring | 5 US-naive EMTs | 1 healthy volunteer and a phantom model | Four-quadrant FAST exam and extended FAST view of anterior chest | Image quality (five-point Likert score), agreement between expert reviewers | Experts deemed images obtained by EMTs to be adequate (Likert score above four in all views) and clinically useful; participates viewed tele-mentoring positively |
| Song, et al 2013 | Feasibility study, simulated prehospital setting, Korea | Determine whether images obtained by EMTs with ALS training and transmitted from ambulance could be helpful for the diagnosis of hemoperitoneum | 1 EMT with ALS and FAST experience | 2 anatomical phantoms | FAST exam ◊ | Sensitivity, specificity, and accuracy of detecting abnormal US results | High sensitivity (90%) and specificity (85.3%), remote tele-ultrasound feasible |
| Becker, et al 2017 | Feasibility study, two urban tertiary ambulance stations, USA | Determine the feasibility of paramedic performed prehospital lung US with remote interpretation in patients with respiratory distress | 17 paramedics with two hours of US training | 34 patients | Bilateral anterior and lateral views of chest | Agreement between EMS physicians, US experts, and ED diagnosis; interpretability/ transmission success rate of scans | Agreement was only fair; image transmission successful in 73.5% of cases, and 58.8% scans were deemed uninterpretable; tele-ultrasound not feasible based on rigorous criteria |
| Marsh- Feiley, et al 2018 | Qualitative study, interviews, UK | Survey paramedic and physician perspectives on remotely-supported prehospital ultrasound | 4 paramedics with one session of US practice | Views on US in context of emergency medicine, legitimacy of remote support in prehospital setting, and anticipated pitfalls and solutions | Paramedics felt optimistic and enthusiastic about prehospital tele-ultrasound while physicians were more skeptical; success depends on effective communication and trust, level of skill, and contextual issues | ||
| Morchel, et al 2018 | Feasibility study, academic medical center, USA | Assess usefulness of extended FAST images obtained by EMTs | EMTs with 12 hours of US training | 20 patients | FAST exam ◊ | Image quality by 11 Questionnaire for User Interaction Satisfaction Scales | Slightly higher ratings of hospital images but statistically insignificant; ambulatory images essentially as good as quality of hospital bedside images |
| Nadim, et al 2021 | Descriptive feasibility study, university hospital, Denmark | Determine feasibility of “treat and release” strategy for patients with respiratory insufficiency | 100 EMTs/ paramedics with six hours of US training |
81 patients | Anterior and lateral zones of each hemithorax | On-scene time, feasibility | Feasible for EMTs/paramedics to perform prehospital ultrasound and blood analyses on patients with COPD and release patients following treatment; ambulances spent longer time on scene (70 minutes) to complete the intervention |
| Leviter, et al 2022 | Feasibility study, tertiary children’s hospital, USA | Evaluate effectiveness of a curriculum involving teleguidance in training paramedics to perform US to confirm endotracheal tube placement | 4 US-naive paramedics | No information provided | Tracheal and bilateral thoracic views | Pre-test and post-test scores, ability to master lung sliding and tracheal US evaluation, learner feedback on remote curriculum | Paramedic test scores increased when completing the curriculum and were sustained for three months; a virtual curriculum with US tele-guidance is an effective tool to train paramedics in confirmation of endotracheal tube placement |
Abbreviations: FAST, Focused Assessment with Sonography for Trauma; US, ultrasound; EMT, emergency medical technician; ALS, Advanced Life Support; EMS, Emergency Medical Services; ED, emergency department; COPD, chronic obstructive pulmonary disease.