Comparing Use of a Prehospital Ultrasound System and Standard Prehospital Care in Thoracoabdominal Trauma

Post-marketing, Single-center, Controlled, Open-Label, Feasibility Study Comparing Use of a Prehospital Ultrasound System and Standard Prehospital Care in Patients With Thoracoabdominal Trauma.

The NanoMaxx Ultrasound System (SonoSite) in connection with the RP-Xpress (InTouch Technologies) provides a means of transmitting ultrasound images, video, and audio to a remote location in real-time. It has been envisioned that this system be used to diagnose trauma patients with suspected pleural effusion, hemothorax, pneumothorax, or abdominal blockage during prehospital care; under the guidance of in-hospital physicians, paramedics would perform an Focused Assessment with Sonography for Trauma (FAST) examination while trauma patients are transported to hospital via ambulance. The investigators hypothesize that in-hospital physicians interpreting ultrasound images obtained by paramedics during trauma patients' transportation to hospital will reduce time to diagnosis; thus, preparations by emergency physicians, surgeons, and operating room teams to receive critically injured patients may begin earlier, reducing time to intervention during a critical period in patient care. Data will also be collected regarding quality of images obtained in-ambulance and the interaction between paramedics and physicians using the remote-presence system.

Inclusion Criteria for FAST cohort:

• Patient is 18 years of age or older
• Patient presenting with blunt or penetrating trauma to the thorax or abdomen
• Patient transported by MD Ambulance to Royal University Hospital
• Patient being transported by a paramedic who has received training in the above ultrasound system and who has with them a NanoMaxx Ultrasound System (SonoSite) to be used in connection with the RP-Xpress (InTouch Technologies)
• Patient will take longer than 10 minutes to transport to hospital
• Patient's care will not be compromised in completing a FAST exam - opinion of paramedic
• Patient's care will not be compromised in completing a FAST exam - opinion of ER physician

Inclusion Criteria for Controls:

• Patient is 18 years of age or older
• Patient presenting with blunt or penetrating trauma to the thorax or abdomen
• Patient transported by MD Ambulance to Royal University Hospital
• Patient will take longer than 10 minutes to transport to hospital

Exclusion Criteria:

• Patients under the age of 18
• Patients whose care would be compromised if other procedures of higher priority (as determined by paramedics and/or remotely-present physicians) were not be able to be executed due to time involved in completing a FAST exam
• Patients who are not being transported to Royal University Hospital
• Patients whose expected transport time from scene to hospital is less than 10 minutes