Point of Care Ultrasound (PoCUS)



A/Prof. Nayana Parange



Assoc. Professor Nayana Parange

MBBS  MS(Medical Sonography)  FICOG  FASA  FAMEE  SFHEA  AFHERDSA  GradCertEd (Univ Teaching)  PhD

Associate Professor in Medical Sonography, Associate Dean: Online Education, Division of Health Sciences, University of South Australia


Introduction

Point of Care Ultrasound (PoCUS) is a type of ultrasound examination performed at a remote site from the medical imaging departments.

A PoCUS arrangement is necessary when:

  • it’s a trauma patient and an emergency;
  • there’s no clinical department where ultrasound equipment is immediately available; and
  • there’s no medical staff trained in ultrasound imaging (such as sonographers or radiologists) immediately available.


Metropolitan Area Emergencies

Examples of when PoCUS medical care is needed, are:

  • emergency medical staff  attending the bedside of an accident patient in the Intensive Care Unit (ICU) or Emergency Department;
  • caring for trauma patient in ambulance transfer to the hospital centre;
  • trauma or neonatal patient requiring emergency medical care in remote country area, town or village.

Medical and allied health professionals have to use small, mobile ultrasound equipment in these PoCUS situations. It can involve any one of a broad group of medical staff – such as, GPs, obstetricians, anaesthetists, doctors in emergency medicine, midwives, nurses or physiotherapists.

In metropolitan accidents, where the patient has suspected internal bleeding, having trained personnel and PoCUS facilities, is vital. Medical staff use PoCUS to help identify whether there’s any life-threatening condition that the accident patient may have. 


Remote Area Emergencies

There are many remote areas inadequately equipped with ultrasound facilities. The need to have the basic ultrasound equipment and the medical staff, PoCUS trained in these areas, is vital.

Using PoCUS for accidents and emergency healthcare of pregnant women are both important remote area needs. PoCUS can save many babies and mothers if employed early. PoCUS can reduce adverse pregnancy in mothers and babies. It’s specially important in remote areas.

Ultrasound is an integral part of ante-natal care. The availability of ultrasound equipment in remote communities, is limited world-wide.  The Australian Aboriginal communities are one of these disadvantaged groups.

Special Emergency Needs for Pregnancy Cases

PoCUS is life-saving for:

  • ectopic pregnancies;
  • recognising low-lying placenta;
  • determining gestational age of the foetus (to plan timing of relocation for delivery); or
  • recognising growth disorders in the baby (if undiagnosed, can lead to stillbirth or neonatal death).

Remote communities have limited or no access to adequate ultrasound services. At present, pregnant women have to fly or drive long distances to obtain basic pre-natal ultrasound scans.

A fly-in, fly-out service is often available in remote areas. Unfortunately, neither the local or visiting nurses, midwives and GPs are PoCUS trained.


What’s the PoCUS Solution for Remote Areas?

Up-skilling the local midwives and rural GP health providers for PoCUS would provide a front-line, first-port-of-call healthcare source for local mothers and babies. The local health centre would have basic ultrasound facilities to provide them medical attention and advice.

The locally trained medical professionals could provide a timely local healthcare support service which:

  • helps to identify any life-threatening conditions requiring urgent action;
  • provides more adequate local medical support; and
  • can arrange transport for urgent cases to go to a metropolitan major centre.

Assoc. Professor Nayana Parange, 10 September 2019