Objectives & Background The Edinburgh 3RU paramedics have some advanced training in cardiac arrest (CA) management

The PUCA study aimed to see whether pre-hospital paramedics can

• ▸ be trained to perform and [2] interpret pre-hospital ELS

• ▸ retain ELS performance and interpretation skills

• ▸ perform satisfactory pre-hospital ELS

• ▸ perform pre-hospital ELS without impacting CA care

Methods Phase 1 – Testing/purchasing a suitable ultrasound machine

Phase 2 – Formal classroom based training: one-day training course with practical and moulage sessions.

Phase 3 – Field based training.

Phase 4 – Prospective observational study of pre-hospital paramedic ELS using saved ultrasound clips and wearable camera videos.

Results During classroom based training, all paramedics could obtain parasternal (PS) and subxiphoid (SX) images.

▸ 88% of attempts in both views were successful in the pulse check window.

▸ Theoretical knowledge improved (mean pre vs post course score 54% vs 89%; p<0.001) and at 10 weeks was non-significantly reduced (82%; p=0.13) but less so than practical performance (75% SX success, 25% PS success).

▸ By Sep 2015, 8 of 11 paramedics who attended initial training, had passed a triggered competency assessment and were practicing pre-hospital ELS independently.

▸ Between 23rd June 2014 and 31st Jan 2016, seven 3RU paramedics attended 45 patients suffering out-of-hospital CA where resuscitation was attempted and the Venue 40 ultrasound machine was available and used.

▸ 80% of first paramedic ELS attempts produced an adequate view which was excellent/good/satisfactory in 68%.

▸ 44% of views were obtained within the pulse check window with a median time off the chest of 17 seconds (IQR 13–20).

▸ A decision to perform ELS was communicated in 67% and the pulse check counted aloud in 60%.

▸ A manual pulse check was seen to be performed in a quarter of patients and the monitor rhythm checked in 38%.

▸ All decision changing scans involved a decision to stop resuscitation.

Conclusion Paramedics can perform focussed ELS in the classroom, integrate attempts into simulated CA scenarios and retain some of this knowledge.

▸ They obtain good ELS views in the pre-hospital environment but with longer hands off the chest times.

▸ The quality of life support may be reduced with less obvious pulse and monitor checking.

▸ Paramedic pre-hospital ELS is more likely to be performed in patients where discontinuation of resuscitation is being considered.

▸ Further training should focus on improving ELS situational awareness.