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www.supersonicimagine.com For everything that really counts in ultrasound UltraFast™ Imaging with - ShearWave™ Elastography - UltraFast™ Doppler EUROPEAN HOSPITAL Vol 23 Issue 5/14 ULTRASOUND Anaesthetist guides flight docs on the routine use of portable machines POC ultrasound takes to the skiesGiven their quality, small size, portability and robustness, SonoSite point-of-care ultra- sound systems play vital roles in hectic A&E and surgical depart- ments, and also in monitoring patients in transit. Working in Berufsgenossenschaftliche Unfallklinik (BGU), Tübingen, anaesthetist Dr Rüdiger Eichholz believes in the importance of POC ultrasound and has set up a training programme for clini- cians who accompany patients with International SOS. For years, Dr Rüdiger Eichholz has found point-of-care (POC) ultra- sound invaluable in anaesthesia, ICU and trauma medicine for FAST scanning (Focused Assessment Sonography for Trauma), ultra- sound-guided nerve blocks and vas- cular access, plus general cardiac, chest and abdominal scanning. At BGU, a trauma, orthopaedic, plastic and craniofacial surgery cen- tre, a large part of his work involves performing regional anaesthesia under ultrasound guidance. As a certified DEGUM trainer, he also spends considerable time travelling, demonstrating ultrasound’s advan- tages and encouraging and train- ing clinicians to routinely use the technique. As a co-ordinating doctor for the German branch of International SOS, Dr Eichholz talked to patients, assessed their needs and helped to solve all kinds of medical prob- lems. This included undertak- ing face-to-face consultations and often evacuations or repatriations. Although termed ‘emergencies’, the SOS flights do not go directly to or from an accident or major incident, but focus on patient transfers. All journeys are elective, with some degree of planning and prepara- tion involved, consent from the patient or relatives, payment and insurance details, and agreement and discussion with the releasing and accepting hospitals. While some patients are quite ill, others are not; sometimes the team moves a fairly healthy patient. Some repatria- tions are simply about transferring a patient to a more sophisticated medical centre to ensure nothing serious is overlooked, especially if surgery is needed. When Dr Eichholz was approached to join the International SOS Abu Dhabi team as a flight physician he found the aircraft was equipped with a new NanoMaxx system, which proved invaluable during patient transfers. ‘While I’m very familiar with using POC ultra- sound in this setting, I discovered that many of the team only occa- sionally used ultrasound and were not entirely at ease with the tech- nique, or aware of its full poten- tial in performing diagnostic pro- cedures and needle guidance,’ he said. ‘So, we established a training programme at International SOS, using my knowledge and teaching experience to explain the advan- tages of POC ultrasound to help flight doctors to make the most of its diagnostic capabilities.’ Based on the AEN (Armbruster Eichholz Notheisen) training con- cept developed by Dr Eichholz and fellow anaesthetists Dr Wolf Armbruster (Evangelisches Krankenhaus Unna) and Dr Thomas Notheisen (BGU), the teaching programme (English language) is adapted to aero-medical issues; it uses similar methods, 3D imaging and hands-on sessions with small classes. The M-Turbo and the NanoMaxx are ideal devices, both for the application and for teaching, as Dr Eichholz pointed out. ‘The system’s robustness, portability and quick boot-up time are all very important on air ambulances and, although we have power packs on board, it’s also very convenient to have a good battery life.’ ‘For training purposes, it’s impor- tant to have a system that’s small, simple to operate and easy to under- stand from the technical perspec- tive, and both these systems, espe- cially the NanoMaxx, fit this profile perfectly. The ease of use has been especially important in establish- ing the programme because, while most of the doctors could see a role for POC ultrasound, many were cautious and not happy with their knowledge and skill levels.’ To help build confidence, the team introduced pre-flight scans for even healthy, walking, talk- ing patients. ‘In this way, flight doctors practise their ultrasound skills, develop a routine pattern of examination, learn to differenti- ate between normal and abnormal images, and ultimately gain con- fidence in their scanning abilities. The pre-flight scans also give a comprehensive baseline picture of each patient before a flight, and are entered into that individual’s elec- tronic file for future reference.’ Several training courses have taken place and a systematic in-flight manual has been prepared, with a checklist and ‘how to’ guidance on the device, plus specific example guides for the most frequently used techniques, e.g. how to examine the chest, heart or vessels before vascu- lar access. ‘My main aim has been to continue to pass on my enthusi- asm for using ultrasound – and so far so good! The programme has been very warmly received, with the potential to make it available to International SOS doctors world- wide,’ Dr Eichholz concluded. Point-of-care (POC) testing aims to gain faster diagnostic results and treatment by assessing a patient at the bedside or during transit. Surgeons, emergency doctors, and sometimes paramedics use Focused Assessment Sonography for Trauma (FAST) to screen for pericardial effusion or fluid around the abdominal organs following trauma. Europe has many air ambulances and commercial aircraft available for patient transfers, but facilities in some geographical regions are more basic and unpredictable. Thus the Middle East Asia branch of International SOS, in Dubai, keeps its own Lear jet ambulances around the region, fully staffed and equipped as intensive care units. Dr Rüdiger Eichholz, anaestetist, Berufs genossenschaftliche Unfallklinik (BGU) 8

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