Guiding Emergency Treatment With Extended Focused Assessment With Sonography in Trauma by Emergency Responders (GET eFASTER)

Objective: Prehospital medicine has struggled to manage critical patients without the resources available to hospital-based teams. Point-of-care ultrasound could bridge this resource gap by providing critical insight into the pathology of trauma patients. This study aimed to determine if early positive extended focused assessment with sonography in trauma (eFAST) identification would lead to improved patient outcomes. Methods: This is a prospective observational trial that took place from February 1, 2019, to August 13, 2021. Paramedics, with no prior ultrasound experience, at a single ground ambulance agency were trained in obtaining and interpretating eFAST examinations. Results: Thirty-seven paramedics were trained and performed a total of 502 eFAST examinations with a total correct interpretation rate of 97.35%. There was a sensitivity of 30.0%/75.0%, specificity of 98.75%/94.05%, a positive predictive value of 33.33%/37.5%, a negative predictive value of 98.55%/98.75%, a positive likelihood ratio of 24.05/12.6, and a negative likelihood ratio of 0.71/0.27 for all exam/patient-only scans. The time spent on scene for eFAST and non-eFAST calls was not significantly different (F_{3, 2,512} = 2.59, P = .051, η² = .003). Conclusion: Although we were able to show successful training and interpretation of eFAST with paramedics, given the low prevalence of disease, our study did not show eFAST use improving patient outcome. However, the large likelihood ratio suggests its benefit may lie with appropriate trauma resource utilization.