Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-14T07:17:21.019Z Has data issue: false hasContentIssue false
  • English
  • Français

Portable Handheld Ultrasound in Austere Environments: Use in the Haiti Disaster

Published online by Cambridge University Press:  17 May 2012

Meghan Shorter  and
Darryl J. Macias
Meghan Shorter
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico USA
Darryl J. Macias*
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico USA
*
Correspondence: Darryl J. Macias, MD Department of Emergency Medicine MSC 10 5560 1 University of New Mexico Albuquerque, NM 87131 USA E-mail dmacias@salud.unm.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

A 7.0 magnitude earthquake struck Haiti on January 12, 2010, resulting in 222,000 deaths and 300,000 injuries. Three weeks after the initial quake, the New Mexico Disaster Medical Assistance Team (NM DMAT-1) was deployed to Haiti for ongoing medical relief. During this deployment, a portable handheld ultrasound machine was tested for usefulness in aiding with patient care decisions.

Objective

The utility of portable ultrasound to help with triage and patient management decisions in a major disaster setting was evaluated.

Methods

Retrospective observational non-blinded images were obtained on 51 patients voluntarily presenting to the Gheskio Field clinic at Port-au-Prince. Ultrasound was used for evaluation of undifferentiated hypotension, torso trauma, pregnancy, non-traumatic abdominal pain, deep venous thrombosis and pulmonary embolism, and dyspnea-chest pain, as well as for assisting with procedures. Scans were obtained using a Signos personal handheld ultrasound machine with images stored on a microSD card. Qualitative data were reviewed to identify whether ultrasound influenced management decisions, and results were categorized in terms of percent of scans that influenced management.

Results

Fifty-one ultrasound scans on 50 patients were performed, with 35% interpreted as positive, 41% as negative, and 24% as equivocal. The highest yields of information were for abdominal ultrasound and ultrasound related to pregnancy. Ultrasound influenced decisions on patient care in 70% of scans. Most of these decisions were reflected in the clinician's confidence in discharging a patient with or without non-emergent follow-up.

Conclusion

The use of a handheld portable ultrasound machine was effective for patient management decisions in resource-poor settings, and decreased the need to triage selected patients to higher levels of care. Ultrasound was very useful for evaluation of non-traumatic abdominal pain. Dynamic capability is necessary for ultrasound evaluation of undifferentiated hypotension and cardiac and lung examinations. Ultrasound also was useful for guidance during procedural applications, and for aiding in the diagnosis of parasitic diseases.

Shorter M, Macias D. Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehosp Disaster Med. 2012;27(2):1-6.

Keywords

abdominal ultrasoundaustere environmentdiagnostic equipmentdisaster responseGheskio Field ClinicHaitihandheld ultrasoundhumanitarian assistancenatural disasterNew Mexico Disaster Medical Assistance Teamportable ultrasoundprocedural ultrasoundqualitative studytriagerelief workultrasonographyundifferentiated hypotension
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 2 , April 2012 , pp. 172 - 177
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Cohen, HL, Moore, WH. History of emergency ultrasound. J Ultrasound Med. 2004;23(4):451-458.CrossRefGoogle ScholarPubMed
2. Training in diagnostic ultrasound: essentials, principles and standards. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1998;875:i-46.Google Scholar
3. American College of Emergency Physicians. Emergency Ultrasound Guidelines. Ann Emerg Med. 2008;53(4):550-570.Google Scholar
4. Lapostolle, F, Petrovic, T, Lenoir, G, et al. . Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. Am J Emerg Med. 2006;24(2):237-242.CrossRefGoogle ScholarPubMed
5. Otto, C, Hamilton, DR, Levine, BD, et al. . Into thin air: extreme ultrasound on Mt Everest. Wilderness Environ Med. 2009;20(3):283-289.CrossRefGoogle ScholarPubMed
6. Wilson, MH, Levett, DZ, Dhillon, S, et al. . Stroke at high altitude diagnosed in the field using portable ultrasound. Wilderness Environ Med. 2011;22(1):54-57.Google Scholar
7. McNeil, CR, McManus, J, Mehta, S. The accuracy of portable ultrasonography to diagnose fractures in an austere environment. Prehosp Emerg Care. 2009;13(1):50-52.Google Scholar
8. Adler, D, Mgalula, K, Price, D, et al. . Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania. Int J Emerg Med. 2008;1(4):261-266.CrossRefGoogle ScholarPubMed
9. Nelson, BP, Melnick, ER, Li, J. Portable ultrasound for remote environments, part 1: feasibility of field deployment. J Emerg Med. 2011;40(2):190-197.CrossRefGoogle Scholar
10. U.S. Geological Survey: Magnitude 7.0 – Haiti Region. http://earthquake.usgs.gov/earthquakes/recenteqsww/Quakes/us2010rja6.php. Accessed January 28, 2011.Google Scholar
11. Sarkisian, AE, Khondkarian, RA, Amirbekian, NM, et al. . Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma. 1991;31(2):247-250.Google Scholar
12. Keven, K, Ates, K, Yagmurlu, B, et al. . Renal doppler ultrasonographic findings in earthquake victims with crush injury. J Ultrasound Med. 2001;20(6):675-679.CrossRefGoogle ScholarPubMed
13. Dean, AJ, Ku, BS, Zeserson, EM. The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster. Am J Disaster Med. 2007;2(5):249-256.CrossRefGoogle Scholar
14. Abuhamad, AZ. Ultrasound outreach and the crisis in Haiti. J Ultrasound Med. 2010;29(4):673-677.CrossRefGoogle ScholarPubMed
15. Shah, S, Dalal, A, Smith, RM, et al. . Impact of portable ultrasound in trauma care after the Haitian earthquake of 2010. Am J Emerg Med. 2010;28(8):970-971.CrossRefGoogle ScholarPubMed
16. Richter, J, Hatz, C, Haussinger, D. Ultrasound in tropical and parasitic diseases. Lancet. 2003;362(9387):900-902.CrossRefGoogle ScholarPubMed
17. de Cassio Saito, O, de Barros, N, et al. . Ultrasound of tropical and infectious diseases that affect the scrotum. Ultrasound Q. 2004;20(1):12-18.Google Scholar
Supplementary material: Image

Shorter and Macias supplementary material

Image

Download Shorter and Macias supplementary material(Image)
Image 1.2 MB