Creating a new‘normal’ for emergency care

Point-of-care (POC) ultrasound is now commonly used in emergency departments throughout the UK. These instruments provide valuable insight for the assessment of both trauma and non-trauma patients, as well as helping to guide procedures such as venous access, insertion of chest drains and aspiration of fluids from thoracic and abdominal cavities. But for many departments, the use of POC ultrasound is limited by a lack of training and poor instrument availability. The Great North Trauma and Emergency Centre – situated in the Newcastle upon Tyne Hospitals NHS Foundation Trust’s Royal Victoria Infirmary – has begun a long-term initiative to integrate ultrasound into its routine clinical practices, implementing a multi-system approach and broad training programme to maximise uptake of this technology.

The four key ultrasound skills that a junior doctor training in emergency medicine in the UK is required to learn are FAST scanning, aortic aneurysm screening, basic echocardiography and venous access. These are the day-in, day-out procedures performed up and down the country, but the list of potential applications for POC ultrasound in an emergency setting is virtually endless. As interest in this technology continues to grow, doctors are using ultrasound for an increasingly broad range of applications, from more advanced echocardiography and thoracic scanning to bladder volume scanning and looking for ocular problems. In some Trusts, ultrasound is becoming a routine part of assessing patients coming into the department. 

There is a growing body of evidence showing that POC ultrasound is more specific and often more sensitive than traditional approaches for many emergency medicine applications, both for the assessment of patients and for the guidance of interventions. The key to increasing its use is creating a culture where ultrasound scanning is considered to be part of ‘normal’ patient assessment and management, rather than being an ad hoc diagnostic tool.