Die Anwendung und Auswirkung von Point-of- Care-Ultraschall in der prähospitalen Phase durch Notfallsanitäterinnen und Notfallsanitäter
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Abstract
Point-of-care ultrasound (POCUS) has become an increasingly important
diagnostic tool in emergency medicine in recent years and, facilitated by the
availability of portable ultrasound devices, is being used more frequently in the
prehospital setting. While the benefits of POCUS in in-hospital emergency care
are well established, data on its autonomous use by non-physician emergency
medical personnel in Germany have so far been limited. The aim of this study
was to investigate the feasibility, safety, diagnostic accuracy, and clinical impact
of prehospital POCUS when independently performed by paramedics.
The study was conducted as part of the “Prehospital POCUS Project” of the
German Red Cross (Deutsches Rotes Kreuz, DRK) Fulda. Twelve certified
paramedics participated in a structured training program based on a blended-
learning approach. This program included guided self-directed learning,
interactive lectures, hands-on ultrasound workshops, case-based simulation
training, and a two-day clinical internship in a central emergency department. The
training content was aligned with established and internationally recognized
POCUS protocols and comprised lung ultrasound (LUS), extended focused
assessment with sonography for trauma (eFAST), the rapid ultrasound in shock
and hypotension (RUSH) protocol, focused echocardiography, and ultrasound-
guided vascular access. Following successful completion of the training, each
participant was provided with a personal mobile ultrasound device for use during
routine emergency medical service operations.
Ultrasound examinations were independently performed by the paramedics
during real prehospital missions and documented using standardized protocols.
Data collected included indications for ultrasound use, image quality,
sonographic findings, and the subjectively perceived impact on clinical decision-
making. To assess diagnostic safety, prehospital ultrasound findings were
compared with final in-hospital diagnoses.
The results demonstrate that, following training, paramedics are able to apply
POCUS safely and correctly. The most common indications for ultrasound use
were dyspnea, trauma, undifferentiated shock, and undifferentiated abdominal
pain. In a relevant proportion of missions, the use of ultrasound influenced
prehospital management, particularly with regard to the assessment of potential
differential diagnoses. Comparison of prehospital ultrasound findings with final
clinical diagnoses revealed an overall sensitivity of 87.88% and an overall
specificity of 92.65%, indicating high diagnostic accuracy.
In addition to its diagnostic value, the implementation of POCUS contributed to
changes in patient allocation to hospitals. Triage urgency, activation of trauma
bay alerts, and the selection of destination hospitals and specialty departments
were significantly influenced by ultrasound findings. The applied blended-
learning training concept proved to be feasible and effective within the context of
routine emergency medical service operations.
In conclusion, this study demonstrates that, following adequate training, POCUS
can be safely, effectively, and autonomously performed by paramedics in the
prehospital setting. The integration of POCUS into prehospital emergency care
has the potential to improve diagnostic precision, optimize time-critical clinical
decision-making, and further advance emergency medical services. Further
prospective studies with larger sample sizes are required to systematically
evaluate its impact on patient safety, clinical outcomes, and healthcare system
efficiency.
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Except where otherwise noted, this item's license is described as Attribution 4.0 International