The Thurston County Prehospital POCUS Experience

Anders Conway, MD
Thurston County Medic One
Sarah Gartner, MD
Evergreen Emergency Services and Northeast King County Medics, Washington
Myles Melton, MD
Thurston County Medic One

In Thurston County, Washington the Medic One system enlisted local emergency physicians to create a point of care ultrasound (POCUS) program beginning in 2022. The initial pilot program with 12 paramedics in 2022 then led to an expanded training program beginning in 2023. Over a three-year period, a total of 80 paramedics received training in Pulmonary, Cardiac, RUSH, and E-FAST studies along with procedural guidance for peripheral IVs. Quality review of studies is completed regularly along with case review. Evaluation of outcomes is underway as this program’s data may help direct efforts in other prehospital sites moving forward. The implementation of POCUS into the prehospital environment is exciting but still nascent or even nonexistent in many areas. Ensuring that development occurs in a safe and effective manner will maximize benefit for patients while avoiding pitfalls that can occur when technologies are newly applied.

In order to successfully create a prehospital POCUS program, the Thurston County experience has led us to believe that this is best achieved with an initial pilot program on a smaller scale that is allowed time to create system-wide interest while program leaders can assess and adapt the pilot before it is expanded. Our program enlisted local emergency medicine physicians to both teach paramedics and act as ambassadors of the new prehospital POCUS program to providers within the hospital. We believe emergency medicine (EM) physicians are best positioned to lead the introduction of POCUS to the prehospital setting for three reasons: 1. Contemporary EM training develops expertise in POCUS. 2. They interact with paramedics regularly. 3. EM physicians communicate with providers throughout the hospital system, facilitating understanding, dialogue and feedback between prehospital and hospital care providers.

Though EM physicians were a necessary component for our implementation, other team members were equally vital. Program managers acquired ultrasound machines, tablets, gel, and cleaning supplies among other physical materials. Fire lieutenants and chiefs created new standardized work flows to ensure efficient machine storage, deployment and maintenance on the medic units and at the fire stations. IT personnel and quality specialists created streamlined processes of image storage, interpretation, review and feedback. All of these stakeholders had to work together closely planning the timelines for training, field implementation, quality management and improvement to maximize success. Before a system considers adding POCUS to its prehospital environment, it is important to have strategic meetings to consider the wide range of potential needs such a program may create.

Finally, implementing POCUS in the prehospital environment requires a culture shift. When experts are asked to adapt a new technology, one can expect both constructive criticism as well as resistance to changing already well-functioning practices. In Thurston County many experienced paramedics have embraced POCUS to improve diagnostic accuracy and manage critical illness. New medics here have begun to develop their practice with POCUS as a fundamental tool of their trade.

If you have experience in creating similar programs or have interest in getting involved in projects such as these, consider joining the ACEP Prehospital, Austere and Tactical Ultrasound Subcommittee!

We actively seek innovative ideas from our members to enhance ultrasound practices in resource-constrained settings. Please reach out to co-chairs Sean Scott (sean.e.scott4@gmail.com) or Sarah Gartner (smgartner94@gmail.com) if you have any questions. See our website for further information with the link below.