Rethinking Prehospital eFAST: A Thoracic-First, Time-Conscious Algorithm
DOI:
https://doi.org/10.31247/agnj.v3iS1.98Keywords:
Prehospital ultrasound, Point-of-care ultrasound (POCUS), Pneumothorax, Hemoperitoneum, Prehospital trauma care, Lung ultrasound, eFAST, TraumaAbstract
Study objective Although extended focused assessment with sonography for trauma (eFAST) shows high diagnostic accuracy in hospital settings, prehospital deployment introduces distinct constraints that justify rethinking the algorithm. We therefore developed a time-conscious, prehospital ultrasound algorithm for advanced life support (ALS) paramedics that prioritizes findings with immediate therapeutic implications in trauma care. This abstract narratively reports the development, the most influential evidence, and the resulting protocol.
Methods We conducted a focused literature review on prehospital eFAST, summarized the key findings narratively, and present the iteratively developed algorithm that was implemented as standard of care within the Medizinercorps Graz.
Results Existing evidence indicates that prehospital eFAST can be performed in less than three minutes, while showing diagnostic limitations, with pooled sensitivity for hemoperitoneum of 63% (specificity 97%), implying a clinically relevant false-negative rate.[1] Conversely, lung ultrasound demonstrates high diagnostic performance for pneumothorax (81 % sensitivity/98 % specificity), targets immediately life-threatening and actionable pathologies, requires fewer windows and shows higher interrater reliability. Prehospital ultrasound appears to change care in approximately 2.7 % of cases, primarily through thoracic applications, such as avoiding unnecessary needle thoracostomy and guiding resuscitation.[2,3] Based on these findings, we developed a thoracic-first, time-conscious algorithm (Figure 1) designed to optimize prehospital ultrasound application in trauma, that was implemented in ALS paramedic training and patient care alongside protocols for cardiopulmonary resuscitation and dyspnea.
Discussion By prioritizing thoracic assessment over a full eFAST, the proposed algorithm obtains immediately actionable findings, shortens examination time, and targets pathologies – particularly pneumothorax – most likely to benefit from prehospital intervention.[3,4] When time permits, e.g. during transport, additional abdominal views may influence clinical course of action in Graz, where detection of free intraperitoneal fluid triggers the in-hospital massive hemorrhage protocol.
References
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van der Weide L, Popal Z, Terra M, et al. Prehospital ultrasound in the management of trauma patients: Systematic review of the literature. Injury. 2019;50(12):2167-2175.
