TY - JOUR T1 - THE PARAMEDIC ULTRASOUND IN CARDIAC ARREST STUDY JF - Emergency Medicine Journal JO - Emerg Med J SP - 912 LP - 913 DO - 10.1136/emermed-2016-206402.27 VL - 33 IS - 12 AU - MJ Reed AU - L Gibson AU - P Black AU - A Dewar AU - G Clegg AU - S Short Y1 - 2016/12/01 UR - http://emj.bmj.com/content/33/12/912.abstract N2 - Objectives & Background The Edinburgh 3RU paramedics have some advanced training in cardiac arrest (CA) managementThe 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 machinePhase 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. ER -