Document Type : Original Article


1 Department of Emergency Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran

2 Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran. Iran


Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting.
Methods: In this quasi-experimental study, 107 EMTs affiliated to Shahid Beheshti and Kashan Universities of Medical Sciences, were randomly selected. At first, the EMTs were given a pre-test of five images concerning normal and abnormal ultrasound views of thoracic and abdominal cavities. Then, 6 hours of theoretical and practical sessions were done by emergency medicine specialists to teach the EMTs to use ultrasound for the detection of pneumothorax and free fluid. The EMTs were tested again in the form of 18 images post-test as well as a 13-item survey to evaluate their skills in taking correct 10 E-FAST.
Results: A total of 107 EMTs with the mean age of 27±15.21 and average of 3.5 years work experience participated in this study. The mean of test score increased from 0.57± 0.19 to 0.81±0.08 (with P < 0.001) out of the total score of 100. In the 4-graded survey, 98% of EMTs obtained good to excellent grades in working with ultrasound machine. Also, 50.5% of EMTs were good in taking Morison’s view and 46.6% and 45.6% had medium grades in pericardial and splenorenal views, respectively. In addition, 22.3% had weak grades in taking pericardial views.
Conclusion: The results of the present study showed that the implementation of the training course significantly improved the accuracy of free fluid detection in thoracic and abdominal cavities by EMTs.


Main Subjects

1. Bost N, Crilly J, Wallis M, Patterson E, Chaboyer W. Clinical handover of patients arriving by ambulance to the emergency department–a literature review. Int Emerg Nurs 2010; 18(4): 210-20. doi:10.1016/j.ienj.2009.11.006.
2. Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, et al. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006; 93(2): 238-42. doi: 10.1002/bjs.5213.
3. Heegaard W, Plummer D, Dries D, Frascone RJ, Pippert G, Steel D, et al. Ultrasound for the air medical clinician. Air Med J 2004; 23(2): 20-3. doi: 10.1016/j.amj.2003.12.006.
4. Richards JR, Schleper NH, Woo BD, Bohnen PA, McGahan JP. Sonographic assessment of blunt abdominal trauma: a 4-year prospective study. J Clin Ultrasound 2002; 30(2): 59-67. doi: 10.1002/jcu.10033.
5. Poletti PA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 2003;227(1): 95-103. doi: 10.1148/radiol.2271020139.
6. Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock 2012; 5(1): 76-81. doi: 10.4103/0974-2700.93116.
7. Ketelaars R, Reijnders G, van Geffen GJ, Scheffer GJ, Hoogerwerf N. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J 2018; 10(1): 17. doi:10.1186/s13089-018-0099-y.
8. El Zahran T, El Sayed MJ. Prehospital ultrasound in trauma: a review of current and potential future clinical applications. J Emerg Trauma Shock 2018; 11(1): 4-9. doi: 10.4103/jets.jets_117_17.
9. Rudolph SS, Sørensen MK, Svane C, Hesselfeldt R, Steinmetz J. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients--a systematic review. Resuscitation 2014; 85(1): 21-30. doi: 10.1016/j.resuscitation.2013.09.012.
10. Taylor J, McLaughlin K, McRae A, Lang E, Anton A. Use of prehospital ultrasound in North America: a survey of emergency medical services medical directors. BMC Emerg Med 2014; 14: 6. doi: 10.1186/1471-227x-14-6.
11. Heegaard W, Hildebrandt D, Spear D, Chason K, Nelson B, Ho J. Prehospital ultrasound by paramedics: results of field trial. Acad Emerg Med 2010; 17(6): 624-30. doi:10.1111/j.1553-2712.2010.00755.x.
12. Walcher F, Kirschning T, Müller MP, Byhahn C, Stier M, Rüsseler M, et al. Accuracy of prehospital focused
abdominal sonography for trauma after a 1-day handson training course. Emerg Med J 2010; 27(5): 345-9. doi:10.1136/emj.2008.059626.
13. Noble VE, Lamhaut L, Capp R, Bosson N, Liteplo A, Marx JS, et al. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Educ 2009; 9: 3. doi: 10.1186/1472-6920-9-3.