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  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.
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