The use of ultrasound in the care for emergency patients, particularly those with traumatic injury to the torso, began in Europe and spread to North America in the 1990s.
Emergency physicians soon recognized that bedside emergency ultrasound (BEU) could prove invaluable in the evaluation of other emergent conditions (e.g. abdominal aortic aneurysm, ectopic pregnancy, cardiac arrest with pulseless electrical activity).
In the evaluation of these and other conditions, BEU is considered limited or "goal-directed," and is intended to answer a specific question: Is the aorta normal or enlarged? Is there an intrauterine pregnancy? Does the patient have a pericardial effusion?
Similar to an EKG, ophthalmoscope, or bedside glucometer, in the hands of a properly trained emergency physician, BEU affords acute patients the very best in timely, appropriate medical care.
Unlike the use of ultrasound in other settings, emergency ultrasound is unique in that it is performed at the bedside, often on an unstable patient, by the treating physician rather than a technologist, and that decisions regarding patient management are made in real time. BEU has, in fact, been described as an extension of the physical exam.
In 1994 the Society for Academic Emergency Medicine published the first model curriculum for the training of emergency physicians in BEU.
In 1999, the AMA House of Delegates, acknowledging the "broad and diverse use and application of ultrasound…in medical practice," resolved that "ultrasound imaging is within the scope of practice of appropriately trained physician specialists," and that hospitals develop credentialing requirements "in accordance with recommended training and education standards developed by each physician's respective specialty" (HOD Resolution 802, 1999).
In 2001, the Residency Review Committee for Emergency Medicine made bedside ultrasound an "embedded requirement" of residency training, and the American College of Emergency Medicine (ACEP) published a policy statement affirming its view that "bedside ultrasound imaging is within the scope of practice of emergency physicians" and that "training in performing and interpreting ultrasound…should be included in emergency medicine residency curricula."
As a testament to how commonplace BEU has become, television viewers now routinely see emergency physicians using ultrasound on episodes of "ER"!
The ACEP policy statement recommends that an emergency physician receive didactic training and hands-on experience to become proficient in BEU. The former may consist of either formal training in an emergency medicine residency program, or for physicians not exposed to such training during residency, a comprehensive course in emergency ultrasound.
There are six commonly recognized "primary applications" for BEU. These applications, and the minimum number of training exams ACEP recommends for proficiency are outlined below:
These applications, and the minimum number of training exams ACEP recommends for proficiency are outlined below:
| Primary Application
|| Training Exams
|FAST (Focused Abdominal Sonography in Trauma)
|Early pregnancy transabdominal transvaginal
The ACEP guidelines further state that in order for a training scan to count towards credentialing, the findings of the scan must be confirmed by direct supervision, overread of saved images, other confirmatory testing (ultrasound, CT, MRI, etc.), or clinical outcome.
Our residency program has fully integrated the use of ultrasound into clinical practice at University of Cincinnati Medical Center, our main teaching hospital, as well as two community facilities, West Chester and Jewish Hospitals, where residents also rotate.
Credentialing for attendings is based on the ACEP guidelines. The emergency ultrasound training program, directed by Steve Carleton, MD, PhD includes a three-week rotation during the intern year.
Our department also relies on weekly teaching sessions in the ED by a professional sonographer, Pattie Smith, RDMS.