Echocardiography Performed by Combat Medics: A Feasibility Study

Prehospital and Disaster Medicine, vol. 40, pp. 313–318

Abstract

INTRODUCTION: Echocardiography is the preferred method for the visual assessment of bubble load in divers. This study evaluates the feasibility of a microteaching program for training combat medics to perform ultrasound measurements using echocardiography for self-monitoring decompression stress on the waterside. MATERIALS AND METHOD: A microteaching was provided to combat medics of the Netherlands Armed Forces. Participants used a handheld ultrasound device connected to a tablet. After two minutes practice time, medics performed and recorded videos on randomly assigned partners while being assessed by an anesthesiologist. Three outcomes were measured: (1) observer-assessed performance adapted from Objective Structured Assessment of Technical Skills (OSATS); (2) self-perceived procedure experience; and (3) video recording quality on a five-point scale. RESULTS: All 21 combat medics completed the microteaching program. Three out of 21 video recordings were lost due to technical issues. All participants successfully obtained at least a partial cardiac view (median time: 61 seconds). Performance scores indicated near-competence across preparation, time-motion, and procedural flow. Image quality ratings by two reviewers showed near-perfect intra-rater agreement (κ = 0.904 and κ = 0.960) but substantial inter-rater variability (κ = 0.671); the assessor's median scores were 2.75 and 3.0 out of 5.0, respectively. Most recordings received average scores of 3.0 or higher. CONCLUSION: This study demonstrates that combat medics, following a brief microteaching session, were able to acquire cardiac ultrasound images partially suitable for assessing vascular gas emboli (VGE). These findings support microteaching as a feasible first step in echocardiography training for combat medics in austere environments.

Authors 6

1. Benjamin L. Turner corresponding
   Affiliation as printed

   Diving Medical Centre

   Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands

2. JC van de Voort Aachen Department of Surgery, Alrijne Hospital

   Erasmus MC · Alrijne Ziekenhuis

   Affiliation as printed

   Department of Surgery

   University Medical Centre Rotterdam

   Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands

   Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

3. CM Fransen

   Ministry of Defence

   Affiliation as printed

   Ministry of Defense

   Ministry of Defense, The Netherlands

4. CMH Obbink

   Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Haaglanden Medisch Centrum

   Department of Radiology, Haaglanden Medisch Centrum, The Hague, The Netherlands

5. Robert P. Weenink

   Amsterdam UMC Location University of Amsterdam · Ministry of Defence · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Ministry of Defense

   University of Amsterdam

   Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands

   Ministry of Defense, The Netherlands

6. Rigo Hoencamp Aachen Department of Surgery, Alrijne Hospital

   Erasmus MC · Ministry of Defence · Alrijne Ziekenhuis

   Affiliation as printed

   Department of Surgery

   Diving Medical Centre

   Ministry of Defense

   University Medical Centre Rotterdam

   Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands

   Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands

   Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands

   Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands