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עמוד בית
Mon, 17.06.24

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

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.

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