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1326. An Abbreviated Curriculum for Paramedics to Perform the FAST Exam in an Ambulance Setting
Authors * Denotes Presenting Author
  1. Donovan Tran *; University of Arizona College of Medicine
  2. Michael Larson; Department of Medical Imaging, University of Arizona
  3. Jeremy Head; University of Arizona College of Medicine
  4. Berndt Schmit; Department of Medical Imaging, University of Arizona
  5. Courtney Williams; Emagine Solutions Technology, LLC
Objective:
In unstable trauma patients, delays in care worsen outcomes. Prehospital ultrasound can be helpful in identifying patients in need of surgical intervention. The goal of this study was to demonstrate that stepwise hands-on training of emergency medical technicians/paramedics (EMT/P) was effective in helping them understand and perform the Focused Abdominal Sonography for Trauma (FAST exam) in the field.

Materials and Methods:
For Phase 1, EMT/P were given a 30 minute lecture on the basics of ultrasound transmission, image acquisition, and to familiarize them with how free fluid appears in Morrison's pouch.They were then given a quiz to test their ability to identify free fluid on control Morrison's pouch images. Next, they had 5-15 minutes of hands-on training before scanning for Morrison's pouch in a moving ambulance on volunteer patients. Afterwards, they were given a follow-up quiz of control Morrison's pouch images. For Phase 2, a 30 minute lecture on the fundamentals of the FAST exam was given followed by a quiz containing control FAST exam images. Next, EMT/P were given 5-10 minutes of hands-on­ FAST exam training before performing the FAST exam in a moving ambulance on volunteer patients. Finally, they were given a follow-up quiz of control FAST exam images.

Results:
After the Phase 1 lecture on ultrasound basics and Morrison's pouch anatomy, EMT/P were able to correctly identify fluid in Morrison's pouch 73% of the time on control ultrasound images. On a follow-up quiz after hands-on training, they were able to correctly identify fluid in Morrison's pouch 85% of the time on control ultrasound images. EMT/P were able to capture diagnostic-quality images of Morrison's pouch on volunteers while in a moving vehicle 71% of the time within 1 minute. After the Phase 2 lecture, EMT/P could correctly identify a positive FAST exam 79% of the time on control ultrasound images. On a follow-up quiz after hands-on FAST exam training, they were able to correctly identify a positive FAST exam 93% of the time on control images. By our metrics, they obtained diagnostic-quality FAST exam images 71.3% of the time and required about 186 seconds per FAST exam on a volunteer patient while in a moving ambulance.

Conclusion:
EMT/P can be trained in roughly 1 hour to perform a FAST exam with over 71% of images meeting diagnostic quality by our metrics. For trauma patients, prehospital FAST exams could better direct trauma center level destination This could enable shorter time to diagnosis and disposition leading to more favorable outcomes in trauma settings.