Feasibility of Bedside Thoracic Ultrasound in the Helicopter Emergency Medical Services Setting



      Bedside thoracic ultrasound has been shown to be a valuable diagnostic tool in the emergency department. The purpose of this study was to evaluate the feasibility of bedside thoracic ultrasound in the prehospital HEMS setting.


      Air ambulance helicopters during patient transportation.


      This was a prospective pilot study. 71 consecutive, nonpregnant patients over 18 years old were enrolled. While in flight, providers completed limited bedside thoracic ultrasounds with the patient supine and recorded their interpretation of the presence or absence of the ultrasonographic sliding lung sign on a closed data-set instrument.


      41 (58%) of the eligible patients had a recorded thoracic ultrasound acquired in flight. The level of agreement in image interpretation between the flight crew and expert reviewer was substantial (Kappa 0.67, CI 0.44-0.90). The reviewer rated 54% of all images as “good” in quality. The most common reason cited for not completing the ultrasound was lack of enough provider time or space limitations within the aircraft cabin.


      The results of this study suggest that, with limited training, bedside thoracic ultrasound image acquisition and interpretation for the sliding lung sign in the HEMS setting is feasible.
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        • MacKenzie EJ
        • Rivara FP
        • Jurkovich GJ
        • Nathens AB
        • Frey KP
        • Egleston BL
        • et al.
        A national evaluation of the effect of trauma center care on mortality.
        N Engl J Med. 2006; 354: 366-378
        • Branas CC
        • Mackenzie EJ
        • Williams JC
        • Schwab CW
        • Teter HM
        • Flanigan MC
        • et al.
        Access to trauma centers in the United States.
        JAMA. 2005; 293: 2626-2633
        • Hunt RC
        • Bryan DM
        • Brinkley VS
        • Whitley TW
        • Benson NH
        Inability to assess breath sounds during air medical transport by helicopter.
        JAMA. 1991; 265: 1982-1984
        • Lichtenstein DA
        • Menu Y
        A bedside ultrasound sign ruling out pneumothorax in the critically ill.
        Chest. 1995; 108: 1345-1348
        • Blaivas M
        • Lyon M
        • Duggal S
        A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.
        Acad Emerg Med. 2005; 12: 844-849
        • Weaver B
        • Lyon M
        • Blaivas M
        Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign.
        Acad Emerg Med. 2006; 13: 239-244
        • Price DD
        • Wilson SR
        • Murphy TG
        Trauma ultrasound feasibility during helicopter transport.
        Air Med J. 2004; 23: 32-34
        • Mazur S
        • Pearce A
        • Alfred S
        • Sharley P
        Use of point-of-care ultrasound by a critical care retrieval team.
        Emerg Med Australas. 2007; 19: 547-552
        • Lyon M
        • Leal B
        • Walton P
        • Siver SA
        Ultrasound detection of the sliding lung sign by critical care transport providers.
        Ann Emerg Med. 2008; 52: S169
        • Cohen J
        A coefficient of agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 213-220
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Brooke M
        • Walton J
        • Scutt D
        • Connolly J
        • Jarman B
        Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naïve advanced paramedics: trialing a PHUS education programme.
        Emerg Med J. 2012; 29: 322-326