Spreading point-of-care ultrasound across northern Spain

The rapid scanning and dynamic imaging capabilities offered by point-of-care ultrasound make it an invaluable tool for emergency medicine. Dr Enrique Ortiz Villacian (from Emergency Services at Donostia University Hospital in San Sebastián) and Dr Juanjo Zafra Sanchez (from the Emergency Unit at San Eloy Hospital in Barakaldo) discussed the role ultrasound plays in their respective emergency departments, as well as their formation of an ultrasound training programme – SonoNorte – for clinicians across northern Spain and further afield.

Point-of-care ultrasound (POCUS) is now widely used by clinicians in numerous medical disciplines, providing valuable insights to supplement clinical examinations and aid patient assessment. The emergency department at Donostia University Hospital was an early adopter of this technology, as Enrique explained: “I first became interested in ultrasound in 2012 when I attended an intermediate ultrasound course for clinicians. I immediately realised the potential and returned to my hospital with a lot of enthusiasm, where I continued my training. A few years later, we acquired a Fujifilm SonoSite S-FAST, which was very intuitive to use and easy to move around the department. We only had two linear and abdominal transducers at the time, limiting its application, but we soon needed a second system to cope with the number of patients we were scanning. We purchased another S-FAST but, to extend our capabilities further, we realised we needed a system that had multiple transducers that we could switch between quickly and easily. We looked at a number of brands, but nothing else was as robust or easy to clean as the SonoSite instruments, and only Fujifim SonoSite offered a five-year warranty. In the end, we bought two Edge II systems equipped with linear, cardiac and abdominal transducers, and I now use ultrasound for almost everything! It allows you to rapidly triage patients with complete confidence, shortening waiting times and allowing you to quickly focus on a patient’s underlying condition, as well as performing ultrasound-guided anaesthesia. It also gives patients more confidence, as you can show them the problem on the screen.”

“I would certainly enjoy my job less without POCUS,” added Juanjo. “We definitely use it in a different way to radiologists, but it is extremely useful as an extension of our clinical examination. For example, you can use it to quickly identify and understand pathologies in pregnant women or children without having to expose them to X-ray radiation. I have been using it since 2009, and originally chose an S-FAST because it was very easy to learn to use and offered great image quality. It also starts up very quickly, which is crucial in an emergency situation. We have since upgraded to the latest Edge II system with three transducers, and a large proportion – around 60-70 per cent – of the doctors here are trained to use it.”

Effective, application-specific training is crucial to the success of ultrasound in any medical setting. Both Enrique and Juanjo are dedicated to broadening the use of POCUS across northern Spain and, realising that there was a lack of training available locally, came together to develop the SonoNorte initiative within the EcoSemes educational programme. Enrique continued: “The idea first came about after Juanjo came to Donostia University Hospital to run a basic ultrasound training course. He was looking for somebody local to assist him, and so I volunteered. We then realised that we went to university together, and so kept in contact. We formed a local working group – EcoSemes Euskadi in the Basque Country– and began a regular POCUS podcast together on YouTube.”

Juanjo picked up the story: “We were interested in the innovative approaches to teaching POCUS that were beginning to appear in North America, using both YouTube channels and face-to-face courses, and we wanted to put together something that would allow us to share these techniques with colleagues. We liked the idea of an American-style residential course, as this combined theory and hands-on practice with informal ultrasound training opportunities, so we started a collaboration with coordinators of work groups in Cantabria and Asturias and developed the intermediate sonography course SonoNorte.”

“We now run the course every year,” Enrique added. “There are 30 places available, with six trainers who are experts in emergency ultrasound. Hands-on training is an important part of the course, and we always use SonoSite systems. Fujifilm SonoSite is very supportive, supplying as many instruments as we require, and we are lucky that the local SonoSite representative also joins us, helping to answer any technical questions students may have. This highlights the company’s commitment to ultrasound training, as well as its general approach; Fujifilm SonoSite doesn’t just sell you the equipment, it provides the knowledge, training and maintenance to use it effectively!”

01.01.2020