POCUS Goes Airborne for Helicopter Rescue

July 14, 2020

Emergency doctor Dr. Didier Moens is in charge of rescue missions in the Centre Médical Héliporté (CMH) of Bra sur Lienne, near Liège in Belgium. He believes access to point-of-care ultrasound (POCUS) on emergency helicopters is now essential for improving the care of critically ill patients:

“I’ve worked in emergency medicine for over 20 years, specializing in pre-hospital care. Our helicopter rescues allow us to reach accidents and emergencies swiftly, and transport patients quickly to the nearest adequate hospital—whether that’s from patients’ homes or workplaces, the scene of a road traffic accident or out in remote areas of the countryside. As ultrasound devices have reduced in size over the years, we realized that we could take them out of the ER and use point-of-care ultrasound as an additional tool to aid our clinical examination. This allows us to provide better treatment and anticipate any problems for the patient.”

POCUS provides Dr. Moens with critical information in the pre-hospital setting, and enables him and his team to take actions quicker. This is ideal for emergency situations, where swift action is necessary and can potentially save a life, as Dr. Moens expands:

“If someone is having chest pain or breathing difficulties, for example, we can check if there is fluid on the lungs (pulmonary edema) or a pneumothorax. This examination helps us to pinpoint the problem and see exactly what we are dealing with more clearly, which helps us to make treatment decisions and direct the patient to the most appropriate hospital. It’s the perfect complement to our clinical examination.”

POCUS to the Rescue in Road Accidents

The importance of this approach to guide treatment and save lives was highlighted by an incident with a patient who had suffered an abdominal hemorrhage from a road traffic accident. Dr. Moens recalls how a medical ambulance was initially sent to assess the patient, who was incredibly pale and had low blood pressure:

“It was only with the assistance of POCUS that we could scan her thorax and abdomen and understand the severity of the situation—her liver had been cut in half and she had a lot of fluid (blood) in her peritoneal cavity. This information allowed us to treat the patient for hemorrhagic shock before taking her to the University Hospital. We were able to confidently alert the staff at the hospital of the situation, and avoid sending the patient to the emergency room for a scan at the hospital—instead taking her directly to the operating theater. Having POCUS to perform that initial critical scan before arriving at the hospital most likely saved the patient’s life.”

In another example, a severe head trauma patient was initially stable following a motorcycle accident, but was found to have a partial pneumothorax on the right side of the chest using POCUS. The patient was intubated and ventilated, then transferred to the helicopter for transport to hospital. However, after take-off, he became unstable with major hypotension and was going into a state of shock. Dr. Moens describes how POCUS gave him critical information about the patient’s condition:

“We knew that we actually had a complete tension pneumothorax and were able to act immediately, performing a thoracostomy in flight. The information we gained from POCUS beforehand was vital, as it would have been impossible for me to diagnose the cause of the shock after take-off. Treatment would have been much slower and less effective without this prior knowledge, and could have led to potential cardiac arrest; this information allowed us to provide specific, lifesaving treatment very quickly. POCUS really has become essential to my daily work.”

POCUS Essential for Mountain Rescue in Nepal

In January 2018, Dr. Moens attended the World Congress of Mountain Medicine in Champéry, Switzerland:

“After my lecture, I joined a discussion with members of the Swiss Society of Mountain Medicine (Schweizerische Gesellschaft für Gebirgsmedizin, SGGM) about a trip that they were organizing to the Everest base camps, Kala Pathar and Island Peak, at altitudes of between 5,600 and 6,100 meters. My lecture on pre-hospital POCUS had given the SGGM team the idea of conducting a prospective scientific study on the use of ultrasound to diagnose high altitude pathologies, such as pulmonary or cerebral edema, both of which can quickly become fatal if left untreated.”

Dr. Moens was invited to join the two-week trip, and given the task of putting together the protocol for the study, both technically and medically:

“The first part of the mission was planned for the Khumbu Valley, where we knew it was going to be cold, but were unsure of other technical considerations, such as whether we would be able to charge any of our equipment—it was quite exciting going into the unknown!”

The group’s mission was to follow 21 experienced mountaineers, all in good health:

“We performed clinical examinations and neurological tests every evening, as well as pulmonary and optic nerve ultrasound scans to look for conditions such as altitude sickness, pulmonary edema and cerebral edema. It was definitely an interesting experience; there were many obstacles that we had to overcome, and unexpected situations to adapt to. For example, we hadn’t anticipated that, when the temperature is 10 degrees cooler at 5,300 meters, the gel used for ultrasound scans freezes!”

Although the data from the 15-day trip is still being compiled, Dr. Moens says that the team has already gained some interesting information:

“One patient in particularly was fascinating; using POCUS we were able to detect a pulmonary edema followed by a cerebral edema before the patient displayed any symptoms—it was amazing. In another case, a patient was experiencing excessive coughing and dyspnea at 3,800 meters. A clinical examination didn’t detect any fever but, with the help of POCUS, we were able to see the start of a pulmonary infection, and strongly advise her against continuing the climb. The ultrasound image helped the patient to understand why her climb needed to be stopped, and she instead went to hospital to be administered antibiotics.”

Learn More about POCUS in Nepal

Ultrasound Provides Answers for Rebuilding Lives in Nepal

Point-of-Care Ultrasound on Mt. Everest