Real world evaluation of a distance-supervised ultrasound training programme in a physician-staffed emergency medical...

Introducing point-of-care ultrasound (POCUS) into prehospital emergencies is challenging. This study evaluated a blended POCUS training programme with remote supervision on clinical use and competence in a physician-staffed Emergency Medical Service (EMS).

A prospective observational study considering the RE-AIM framework was conducted over six months in a regional physician-staffed EMS. Board-certified emergency physicians received training in focused protocols for respiratory failure, shock, cardiac arrest, and trauma, combining simulation with real-patient scanning under asynchronous expert supervision. Cases with and without POCUS were compared. Stored clips were reviewed by blinded experts for technical adequacy and interpretation accuracy. Interobserver agreement was measured using Cohen's κ and intraclass correlation coefficient (ICC).

Among 476 calls, ultrasound-trained physicians attended 375 (78.8%). POCUS was performed in 70 cases (18.7% with a trained physician; 38.3% when the primary indication was present). POCUS use was mainly for respiratory distress (47%) and shock (31%), with low trauma use (~ 6%). Use was reduced during overnight shifts (p = 0.0049). Scene time did not differ between POCUS and non-POCUS cases (21.5 vs 20.2 min, p = 0.64). Approximately 40% of scans met all technical quality criteria. Interpretation accuracy was high-experts agreed with trainees in ~ 80% of cases (κ = 0.79, 95% CI: 0.65-0.92); ultrasound diagnoses were confirmed in 85.7% (ICC = 0.87, 95% CI: 0.75-0.96). POCUS patients had higher clinical severity scores (34% vs 17% with p < 0.005). In some of these cases, episodes of cardiac arrest were documented.

Blended training with remote mentorship enabled safe POCUS integration into high-acuity prehospital care without delaying scene time. Ongoing practice and mentorship are recommended to improve image acquisition and sustain skills.