Paramedic and physician perspectives on the potential use of remotely supported prehospital ultrasound

Introduction: Remotely Supported Prehospital Ultrasound (RSPU) is a process in which an ultrasound operator performs a scan and sends images to a remote expert for interpretation. This novel technology has been undergoing investigation in the randomised controlled SatCare trial, which seeks to assess the capability of RSPU to improve patient outcomes and standard of prehospital care in the Highlands of Scotland. This study aimed to explore the views of emergency medicine consultants and paramedics prior to starting the trial.

Methods: An interview schedule was prepared a-priori and was based upon Normalisation Process Theory (NPT), a framework designed to assess ways in which practitioners work to embed novel technologies in clinical practice. Semi-structured interviews were conducted with four consultant physicians and eight paramedics, who were recruited using purposive sampling until theoretical saturation.Analysis used open and hierarchical axial coding, and NPT as a framework to assist in the management and analysis of codes.

Results: The prospect of RSPU evoked significantly different responses from doctors and paramedics. Paramedics thought of RSPU as a logical progression of prehospital care, which addresses core prehospital challenges such as lack of decision-making support and a limited ability to identify life-threatening occult conditions. Paramedics see RSPU as part of a trend to increase their skills and responsibilities, and viewed ultrasound as a validated tool within emergency medicine. Paramedics felt that ultrasound was simple to learn and would be practical for use within the prehospital arena. In contrast, physicians expressed a greater spectrum of views; most saw limited value to prehospital diagnosis and are concerned that RSPU will distract both paramedics and physicians from their existing roles (particularly in the context of the increasing demand and workload within the NHS). Doctors were also concerned that ultrasound skills were poorly incorporated into training and practice in the British emergency medicine system. Furthermore, they believed that ultrasound was difficult to learn, prone to misinterpretation and easy to become deskilled in.  Both sets of participants believed that the relational skills required between the two groups, and the practical complexities of RSPU may pose challenges in its implementation. In particular, concerns were raised regarding the time that would be required to conduct the ultrasound scans and difficulties with transmission and communication in the Highlands. Both groups questioned the likelihood of measurable benefits from RSPU for patients. Furthermore, both groups were unsure how the technology would benefit those patients in urban areas close to the emergency department or whether RSPU would be effectively utilised in rural areas where serious emergencies are infrequent.

Conclusions: There are substantial differences in emergency physician and paramedic perspectives on RSPU, however both parties are willing to engage with the research process. Both groups also have reservations, especially the emergency physicians who perceive significant barriers to the acquisition of skills, as well as the relational and contextual integration of RSPU. This study demonstrates the importance of conversations with doctors and paramedics throughout the research process, particularly as the role of prehospital care remains controversial.