Dr. Michael Mancera and EMS Fellow Dr. Kiriana Morse led efforts to bring point of care ultrasound (POCUS) to Fitch-Rona emergency medical services. This innovative tool allows emergency medical personnel to diagnose conditions more rapidly in the field, thus initiating treatment sooner and potentially saving more lives. It will be used specifically to enhance the care of cardiac arrest patients, but its use is relatively new in the prehospital setting.
The POCUS program, set to serve the cities of Fitchburg and Verona, will equip paramedics with the ability to distinguish between patients in cardiac arrest and those in profound shock, ensuring accurate and timely treatment. Additionally, it assists in confirming cardiac standstill, a critical factor when discontinuing resuscitation efforts. The objective is to make these vital decisions within 30 seconds.
Fitch-Rona EMS Chief Patrick Anderson emphasized the growing adoption of POCUS in prehospital settings, although it remains relatively new. He acknowledged the role of technology advancements and cost reductions in making these systems more accessible. Anderson began by consulting other EMS services in Wisconsin already utilizing POCUS, learning from their experiences to guide Fitch-Rona’s implementation. This program is pioneering in Dane County, requiring state oversight to ensure proper usage.
“Currently, our use of ultrasound in prehospital environments is limited, primarily to cardiac function,” Anderson explained. “While we have various tools like CPR devices, medications, and defibrillators that address most cases, POCUS is invaluable for those uncertain scenarios where traditional methods fall short.”
Despite its advantages, Anderson stressed the importance of appropriate usage. “CPR and defibrillation are proven methods. We must avoid delaying these interventions by over-relying on ultrasound. POCUS is for specific cases where we’re unsure, potentially altering our course of action.”
The department’s 21 full-time and 15 part-time employees are undergoing comprehensive training with the UW Hospital system, whose medical directors are instrumental in navigating the “huge learning curve” associated with POCUS technology. With the third training session recently completed, the team deployed the devices in April.
“This isn’t a skill you master instantly; even doctors need extensive practice to become proficient,” Anderson noted. “The support from UW Hospital has been crucial.”
As medical director and assistant medical director for Fitch-Rona, Drs. Mancera and Morse also designed and coordinated the POCUS training curriculum for paramedic-level providers. “We hope to bring the same types of diagnostic tools being used inside our hospitals and emergency departments out into the community and into the hands of our highly skilled EMS providers,” says Dr. Mancera. The ultrasound devises were provided by a grant from Epic.
“Working to help implement prehospital ultrasound has been one of the highlights of my EMS fellowship and a great learning experience,” says Morse. “It demonstrates the amazing ways our local EMS agencies are helping to significantly advance prehospital care and improve patient outcomes.”
Fitch-Rona EMS the first emergency medical service in Dane County to implement ultrasound devices and one of only a few in Wisconsin now capable of utilizing ultrasound to care for patients in cardiac arrest.
Michael Mancera, MD, is an associate professor of emergency medicine. He serves as medical director for Fitch-Rona and Middleton Emergency Medical Services. Spurred on by his resolve to improve lifesaving outcomes, Dr. Mancera championed the implementation of the Cardiac Arrest Registry for Enhanced Survival (CARES) throughout the local and county EMS system. This national registry allows EMS systems to collect and analyze out-of-hospital cardiac arrest data and compare it to national benchmarks, allowing for local quality improvement efforts and benchmarking capability to improve care and increase survival. Following the implementation of CARES in Dane County, area out-of-hospital cardiac arrests have seen continuous improvement.
Kiriana Morse, MD, is an EMS fellow and assistant medical director for Fitch-Rona EMS.
May 19-25, 2024, marks the 50th Anniversary of EMS Week.