A pilot study examining the viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol

J Emerg Med. 2013 Jan;44(1):142-9. doi: 10.1016/j.jemermed.2012.02.032. Epub 2012 May 16.


Background: Prehospital ultrasound has been shown to aid in the diagnosis of multiple conditions that do not generally change prehospital management. On the other hand, the diagnoses of cardiac tamponade, tension pneumothorax, or cardiac standstill may directly impact patient resuscitation in the field.

Study objective: To determine if prehospital care providers can learn to acquire and recognize ultrasound images for several life-threatening conditions using the Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol.

Methods: This is a prospective, educational intervention pilot study at an urban fire department with integrated emergency medical services (EMS). We enrolled 20 emergency medical technicians--paramedic with no prior ultrasonography training. Subjects underwent a 2-h training session on basic ultrasonography of the lungs and heart to evaluate for pneumothorax, pericardial effusion, and cardiac activity. Subjects were tested on image interpretation as well as image acquisition skills. Two bedside ultrasound-trained emergency physicians scored images for adequacy. Image interpretation testing was performed using pre-obtained ultrasound clips containing normal and abnormal images.

Results: All subjects appropriately identified the pleural line, and 19 of 20 paramedics achieved a Cardiac Ultrasound Structural Assessment Scale score of ≥4. For the image interpretation phase, the mean PAUSE protocol video test score was 9.1 out of a possible 10 (95% confidence interval 8.6-9.6).

Conclusion: Paramedics were able to perform the PAUSE protocol and recognize the presence of pneumothorax, pericardial effusion, and cardiac standstill. The PAUSE protocol may potentially be useful in rapidly detecting specific life-threatening pathology in the prehospital environment, and warrants further study in existing EMS systems.

MeSH terms

  • Adult
  • Cardiac Tamponade / diagnostic imaging*
  • Clinical Protocols / standards
  • Emergency Medical Services / methods*
  • Emergency Medical Technicians / education*
  • Heart Arrest / diagnostic imaging*
  • Humans
  • Male
  • Pilot Projects
  • Pneumothorax / diagnostic imaging*
  • Point-of-Care Systems*
  • Prospective Studies
  • Ultrasonography