Dr. Rommel JADAAN

Specialist in Internal and Emergency Medicine

SUEM 118 (Servizio d Urgenza ed Emergenza Medica- Dr. Aurelio Tommasi), Crespano del Grappa (TV), Italy

Using the technology of Ultrasound in a prehospital setting, not only improves the diagnosis of acute and sometimes life-threatening conditions through the possibility of producing an image that aids the medical doctor and his emergency team to explain a certain clinical condition and/or exclude certain causes. A frequent example is imaging the consequences of trauma . Free liquid in the abdomen or thorax, a Pneumothorax and/or acute pathologies of the heart or main vessels are some of these most common emergency situations.

Ultrasound imaging in a preshospital setting, particularly plays a unique role in diagnosing quickly and non-invasively 3 of the reversible causes of cardiac arrest: High-tension Pneumothorax, Cardiac Tamponade and acute cardiac output failure of massive pulmonary embolism for example..

In addition to all the above mentioned situations, there is one, where using ultrasound technology in a prehospital setting has –in addition to the immense diagnostical advantages- an immense positive psychological impact on the person /s involved: Pregnant women, particularly in advanced stages of pregnancy, because in advanced stages they can feel the movements and instinctively relate “movements of the fetus” with his/her well –Being!

In any kind of emergency, traumatic or non traumatic, mothers and other family members, especially mothers naturally , are very occupied about the health of their fetus. One of the most frequent situations is after a trauma of a car accident, where the dynamic was not of a major grade. In these cases, most of the times, mothers because of the physical trauma and the dynamic, do not feel any movements in their uterus and they start to worry which-again, naturally- could easily turn into panic. A development of this sort could extremely complicate the intervention.

Using ultrasound technology to assure to the mother-and eventually other family members- that, for example the heart of the fetus is still beating, or demonstrating eventual movements of the fetus, will have an immediate positive psychological reassuring effect on the mother and others; something that can render very utile during transport of the patient.

An advantage of this kind during an intervention that most of the team members already defined as “difficult“ after hearing/reading the dispatch, as there is a pregnant woman involved, easily calms the whole setting maintaining the high professional performance of the emergency team members.

2 very important issues should be pointed out:

1) The sonographer must know the most frequent positions where the ultrasound probe should be put (education).

2) In the case of not being able to locate an anatomical feature of the fetus, or in a case of not being able to register any movement or heartbeat he/she must be skilled in communicating this fact to the mother and other family members without using complicated medical phrases or any diagnoses. This explanation should be carried out using the , through education at the university hopefully- acquired and trained ethical mode of communication-keeping in mind that: “Hope is always the strongest fortress in the desert”(*) more importantly using the human common sense, in order to prevent a situation that could become difficult to control without eventually being forced to use medication.

Our observation is that in most of the cases of trauma in pregnant women with a dynamic of a minor or medium grade, using prehospital ultrasound imaging, it was easy to localize the heart of the fetus and to demonstrate to the mother and other family members –as well as the emergency team members- that the heart of the fetus is still beating and that the fetus is still alive, which in that very moment is what –according to all the mothers included in this observation period, was the most important thing to them. The relief in the eyes of the mothers and the spontaneous smile, and so often a teardrop of joy is yet another observation that can be “validated” only by seeing it.

(*) Arab proverb of Jordanian beduins