Ultrasound News: Ultrasound on the Scene
By Dave Yeager
Radiology Today
Vol. 18 No. 12 P. 8

A fast response is the most important aspect of emergency care. Whether the emergency is due to trauma or a biological event such as heart failure or stroke, the sooner treatment can be administered, the better the chances that a patient will survive without lasting injury. Emergency medical technicians (EMTs) are often the first line of defense in these life-or-death matters, but appropriate treatment protocols can be difficult to ascertain in some emergency situations.

To assist EMTs in starting life-saving measures sooner, Point of Care Ultrasound has developed SonicXpress. SonicXpress is a portable ultrasound transmission system that transmits images in real time from the field to physicians who can assess the injuries and direct the imaging. It is compatible with any ultrasound system that has a video output port. The system can perform the same functions as an ultrasound machine in a radiology department, including Doppler and pulse-wave Doppler imaging.

"The idea was to have live streaming transmission from an accident scene to the emergency department so that on-scene decisions could be made by the emergency physician or other specialists, and triage could be more accurate so that the patients who have specific needs could be taken to the appropriate hospital," says Michael Welsh, MD, RDMS, RVT, RDCS, president and founder of Point of Care Ultrasound.

Expanding the Field
SonicXpress can send images and voice communication to any network that is set up to receive transmissions, and the images can be viewed on any device, including notebook and tablet computers or smartphones. Users log in with a username and password, and the system's window pops up on their device. A user list of contacts ensures that the images are transmitted to the intended recipient, and all transmissions are sent through a secure virtual private network.

One of the features of SonicXpress is that it can transmit from rural areas that have limited cellular or Wi-Fi service. Cody Neville, technical developer of SonicXpress, says that if connectivity with one provider is lost, the system automatically switches to another available provider. He says the switches are seamless for users and don't interrupt transmissions.

"We take all of the available connections—they could be satellite, cellular, Wi-Fi—and we merge those connections," Neville says. "And what that allows us to do is, basically, take a little bit of each connection to make sure we have enough bandwidth to send the data from rural areas reliably."

Acquiring ultrasound images, however, requires some training, and Point of Care Ultrasound provides a training curriculum for SonicXpress. Users who are interested can access videos and receive hands-on training to help them become as skilled as possible.

"It's not an automatic that you can just do ultrasound without training," Welsh says.

Potential Uses
Welsh believes the system can be used in a variety of situations. One is pulseless electrical activity, eg, cardiac arrest. He says ultrasound is the best modality to assess pulseless electrical activity.

"It's been known for a long time that the sooner you begin correct resuscitation, the better chance the patient has. And that's way before they hit the emergency department. In cities like Seattle, lay people are trained to do CPR [for this reason]," Welsh says. "Ultrasound is by far the best modality to consider what the cause of pulseless electrical activity is and begin the correct treatment on the scene when there still may be time to save the patient."

Multitrauma victims, such as those involved in auto accidents or injured on the battlefield, could also benefit from this technology, Welsh says. SonicXpress meets military standards for durability related to altitude, drops, humidity, and liquids. It is conformant with military standard 810G and has an ingress protection rating of 65. Welsh says the system could be used to triage which patients to bring for treatment first.

"It's easy to forget in emergency medicine that the patient had the condition much longer than the first second that you see them," Welsh says. "One day, I would love to see a patient taken directly from the field into a surgical suite, and the surgical team will already be scrubbed and begin surgery maybe in the first five minutes after the patient arrives at the hospital."

Michelle Alexander, clinical marketing director of Point of Care Ultrasound, says she has received calls about the system from throughout the United States and the world, including China, India, Israel, Russia, Saudi Arabia, and South Korea. In addition to the previously mentioned uses, she has heard about physicians using the system to conference about a patient to align treatment plans and from academic institutions using it for training purposes. As for other uses, time will tell.

"With the drive nationally to improve telehealth and telemedicine in rural and underserved areas, we've discovered that there are multiple uses that we hadn't ever really thought of," Alexander says.

— Dave Yeager is the editor of Radiology Today.