Evaluation of Dyspnea through Education and Implementation of the Bedside Lung Ultrasound in Emergency (BLUE) Protocol by Prehospital Paramedics

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2023-01-12

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BACKGROUND: It has been demonstrated that emergency medical service (EMS) providers have very poor sensitivity for identifying patients who present with dyspnea due to congestive heart failure versus other causes such as asthma or chronic obstructive pulmonary disease (COPD)1. Prior research has shown that focused lung ultrasound has high accuracy for differentiating respiratory distress in various clinical settings2. Paramedics have the requisite background to obtain adequate prehospital lung ultrasound images3. OBJECTIVES: The goal of this study was to demonstrate that paramedic-performed and paramedic-interpreted lung ultrasound is an accurate diagnostic tool for prehospital advanced life support providers in order to differentiate the etiology of respiratory distress. METHODS: This study was a randomized trial utilizing 911 paramedics to perform both ultrasound and standard, non-ultrasound clinical diagnostics on patients experiencing respiratory distress. Paramedics were trained in ultrasonography and randomized on a per-shift basis to perform ultrasound diagnostics or traditional diagnostics while assessing respiratory patients in the prehospital setting. The primary outcome was the accuracy of the paramedics’ two diagnostic methods compared to the clinical diagnoses determined by in-hospital providers after discharge from either the emergency department or in-patient care. RESULTS: Paramedics from four different EMS agencies (urban, suburban, and rural ground EMS, helicopter EMS) were trained in lung ultrasonography by study personnel. There were 53 patients who underwent focused lung ultrasound by paramedics and 109 patients who had non-ultrasound clinical diagnoses obtained. Paramedics’ diagnoses in both cases were compared to hospital diagnoses. Paramedic ultrasound for dyspnea had an overall accuracy of 79.2% compared to the non-ultrasound diagnostics accuracy of 63.3%. Ultrasound improved the diagnostic accuracy of the paramedics by 15.9% (95% CI [1.8%, 30.1%, p=0.028) compared to traditional protocols and skills. CONCLUSIONS/FUTURE WORK: Ultrasound has been shown to provide statistically significant increase in paramedic diagnostic accuracy for undifferentiated respiratory distress. Further research into improvement in patient outcomes from the application of prehospital ultrasound would likely show benefit from more accurate and precise prehospital interventions.

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