Abstract
Introduction
There are currently no reports on whether telementoring for extended focused assessment
with sonography for trauma (eFAST) improves critical care transport providers’ performance
in prehospital settings. Our objective was to determine the impact of teleguidance
on eFAST performance and quantify workload experience.
Methods
Eight trauma injury modules were selected on simulated patients. Critical care transport
(CCT) providers were tasked to complete one independent and one emergency physician–telementored
eFAST. The time to completion and the percent of correct findings were obtained. Participants
completed the NASA Task Load Index after each iteration to assess workload.
Results
Eight independent and 8 telementored eFASTs were completed. The mean times to complete
the independent and telementored eFAST were 5 minutes 16 seconds (95% confidence interval
[CI], 3 minutes 32 seconds, 6 minutes 59 seconds) and 8 minutes 27 seconds (95% CI,
5 minutes 14 seconds, 11 minutes 39 seconds), respectively (P = .06). The percentage of correctly identified injuries for the independent versus
the teleguided eFAST was 65% versus 92.5% (P = .01). The CCT providers experienced higher mental (P = .004), temporal (P = .01), and effort (P = .004) demands; greater frustration (P = .001); and subjective lower performance (P = .003) during independent trials. The emergency physician experienced higher mental
(P = .001), temporal (P = .02), effort (P = .005), and frustration (P = .001) demands than the CCT members.
Conclusion
The teleguided eFAST yielded higher accuracy than the independent eFAST. The CCT providers
relied on teleguidance of the remote physician when performing the eFAST. Teleguidance
may improve the accuracy of ultrasounds performed by prehospital personnel in real-life
scenarios.
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References
- From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment.Eur J Trauma Emerg Surg. 2016; 42: 119-126
- Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: Experience at a community based level I trauma center.Injury. 2011; 42: 511-514
- Integrating eFAST in the initial management of stable trauma patients: the end of plain film radiography.Ann Intensive Care. 2016; 6: 62
- Tele-ultrasound and paramedics: real-time remote physician guidance of the focused assessment with sonography for trauma examination.Am J Emerg Med. 2011; 29: 477-481
- Performance and skill retention of extended focused assessment with sonography for trauma for the paramedics.Anaesth Crit Care Pain Med. 2021; 40100784
- Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: impact on the management of 756 patients.Injury. 2018; 49: 1774-1780
- Monitoring and telemedicine support in remote environments and in human space flight.Br J Anaesth. 2006; 97: 107-114
- Telemedicine use decreases rural emergency department length of stay for transferred North Dakota trauma patients.Telemed J E Health. 2018; 24: 194-202
- Evolution of telemedicine in the space program and earth applications.Telemed J E Health. 2001; 7: 1-15
- Four virtual-reality simulators for diagnostic abdominal ultrasound training in radiology.Diagnostics (Basel). 2019; 9: 50
- Measuring workload of ICU nurses with a questionnaire survey: the NASA task load index (TLX).IIE Trans Healthc Syst Eng. 2011; 1: 131-143
- Mental Workload Assessment Method. Human Factors Methods: A Practical Guide for Engineering and Design.2nd ed. Ashgate, Burlington, VT2013: 300-305
- NASA-task load index (NASA-TLX); 20 years later.Proc Hum Factors Ergon Soc Annu Meet. 2006; 50: 904-908
- The FAST and E-FAST in 2013: trauma ultrasonography.Crit Care Clin. 2014; 30: 119-150
- Evaluation of a training curriculum for prehospital trauma ultrasound.J Emerg Med. 2013; 45: 856-864
- Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis.CJEM. 2019; 21: 727-738
- Hand-Held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST).J Trauma. 2004; 57: 288-295
- Diagnostic accuracy of the extended focused abdominal sonography for trauma (E-FAST) performed by emergency physicians compared to CT.Am J Emerg Med. 2018; 36: 1014-1017
- eFAST exam errors at a level 1 trauma center: a retrospective cohort study.Am J Emerg Med. 2021; 49: 393-398
- Remote telesurgery in humans: a systematic review.Surg Endosc. 2022; 36: 2771-2777
- Impact of time delay on simulated operative video telementoring: a pilot study.Aerosp Med Hum Perform. 2022; 93: 123-127
Article info
Publication history
Published online: January 16, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
