20 Air Medical Journal 23:2 Ultrasound for the Air Medical Clinician William Heegaard, MD, MPH, 1 David Plummer, MD, 1 David Dries, MD, 2 RJ Frascone, MD, 2 Greg Pippert, MD, 3 David Steel, RN, 3 and Joseph Clinton, MD 1 Introduction Recent advances in technology have made the use of ultra- sound (US) a possibility in air medicine. A handheld US ma- chine that appears promising as a diagnostic tool within the helicopter theater was developed recently (Sonosite Corp., Bothell, Wash.). Several air medical programs have begun us- ing US as the focused abdominal sonography for trauma (FAST) examination during helicopter transport. 1,2 Diagnostic US greatly enhances the evaluation of patients with a variety of presentations. After its rapid evolution dur- ing the previous decade and wide availability in operating suites and emergency departments, US technology now is be- ing introduced into the out-of-hospital arena. Many patients who present with unstable or time-critical medical problems require on-the-spot diagnosis and intervention. These pa- tients may benefit from rapid, goal-directed, limited ultra- sonography performed and interpreted by flight clinicians. We integrated the use of a Sonosite 180 US device in our flight program at Life Link III in April 2001. This article de- scribes our training program for flight clinicians, proposes a platform for subsequent program development, and shares the results of our experience in air medicine. Methods Our objectives were to develop a US training program for air medical clinicians using focused US examinations and as- sess the competencies of each clinician 1 year later. We con- ducted a prospective observational study on critical patients transported by Life Link III between July 1, 2001, and July 1, 2002. Life Link III (LLIII) is a full-service transport program that provides both ground and air critical care services to a tri- state region. LLIII provides more than 6000 ground trans- ports and 1600 air medical flights per year using a registered nurse and paramedic configuration to staff critical care trans- ports. The study site was the St. Paul air medical base of LLI- II, which provides more than 800 critical care air transports per year. During the evaluation portion of our study, all patients that had an US performed were included. A SonoSite 180 was used to conduct the examinations. All images were captured and then downloaded into a PC format and read by one of the authors (Heegaard). All studies were performed within a Bell 222 helicopter. We received no financial assistance from the SonoSite Corp. Ultrasound Training The training program was developed by one of the authors (Plummer) with a focus on a narrow US examination with specific indications, such as hypotension, change in vital signs, high clinical suspicion, etc. The course consisted of 7 hours of didactic and hands-on training designed for a dedi- cated crew of 10 flight nurses and paramedics. All flight nurs- es and paramedics had more than 5 years of clinical experi- ence. The course began with a general introduction to US, US physics, and the use of US within an emergency air medical practice. Emergent US topics then were divided into echocar- diography, abdominal US, pelvic and obstetrical US, and the FAST examination. Each topic was followed by a demonstra- 1. Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota 2. Department of Surgery, Regions Hospital, Minneapolis, Minnesota 3. Department of Emergency Medicine, St. Cloud Hospital, and Life Link III, Minneapolis, Minnesota Address for correspondence: William Heegaard, MD, MPH, Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN 55415; emdoc@yahoo.com Presented at Airmed 2002, Interlaken, Switzerland, September 2002, and the Society of Academic Emergency Medicine, Boston, MA, May 2003. 1067-991X/$30.00 Copyright 2004 by Air Medical Journal Associates doi:10.1016/j.amj.2003.12.006