The goal of this prospective nonrandomized study is to determine if prehospital lung ultrasound findings result in a change in patient management. This study will look at how lung ultrasound exam improves diagnosis of respiratory distress in patients being treated by Emergency Medical Services, such as patients with heart failure. Additional questions include: * How well can paramedics obtain and interpret ultrasound images? * How does ultrasound use change treatment received by patients? * How does ultrasound use impact patient outcomes? Participants will receive a lung ultrasound exam, but otherwise receive standard evaluation and care. Patients who receive ultrasound will be compared to those who did not receive ultrasound for logistical reasons and patients from before the use of ultrasound. Ultrasound will not be withheld from any patient for the purposes of the study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
1,000
Ultrasound of up to six lung zones (1, 2, and 4) will be obtained. Paramedics will assess for the presence of B lines.
Christiana Care/New Castle County EMS
Newark, Delaware, United States
Rutgers New Jersey Medical School/University Hospital
Newark, New Jersey, United States
Frequency with which prehospital lung ultrasound findings result in a change in patient management by EMS
Frequency of management changes will be compared from before prehospital ultrasound was used to after prehospital ultrasound has been implemented.
Time frame: From time of patient encounter to patient handoff at the hospital. (anticipated average of one hour)
Survival to discharge
Time frame: At time of hospital discharge (anticipated average one week)
Percent of prehospital diagnoses agreeing with hospital diagnosis
Diagnostic accuracy
Time frame: At time of hospital discharge (anticipated average of one week)
Whether or not patient is intubated by EMS or during hospital admission, recorded as yes or no
Time frame: EMS patient encounter to hospital discharge (anticipated average one week)
Days on ventilator or non-invasive ventilation
Time frame: Hospital arrival to hospital discharge (anticipated average one week)
Length of stay
Time frame: Hospital arrival to hospital discharge (anticipated average one week)
Length of ICU stay
Time frame: Hospital admission to hospital discharge (anticipated average one week)
Paramedic ultrasound interpretation accuracy
Comparison between paramedic interpretation (of presence of lung sliding and number of B lines) with physician interpretation
Time frame: Enrollment
Quality of ultrasound obtained by paramedic
Rating of ultrasound using a five-point scale (1 being no recognizable structures, 5 being criteria met for diagnosis, all structures imaged with excellent image quality and diagnosis completely supported) by physician
Time frame: Enrollment
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