“The stethoscope has been the tried and true technology for all physicians, but over the past five years or so I have come to think of the portable ultrasound machine as the 21st century stethoscope for ER physicians,” Dr. Hall says.
Patients in the Brantford General Hospital (BGH) emergency department would agree.
“A mother arrived in distress in the middle of the night – she was pregnant and had early bleeding,” Dr. Hall explained. “Within one minute using the portable ultrasound unit we have in our ER, I showed her the baby’s heart was beating. She cried as she said, “You are the greatest person on earth.”
“Another patient’s heart stopped beating properly and required an emergency pacemaker and with the portable ultrasound we safely inserted the pacer quickly and stabilized a critically-ill patient.”
Ultrasound technology has been a staple in health care settings for many years, however, it wasn’t until the past few years that the units became portable and the machines could be brought quickly to the patient’s bedside in hospital ERs.
Dr. Hall recognized the benefits of portable ultrasound technology in the ER setting and soon Brantford General was at the forefront. Dr. Hall and other emergency physicians at the Brantford General became certified Master instructors and over the years hundreds of their peers have come to the hospital to be trained.
“Brantford General is a designated Canadian Emergency Ultrasound Society training centre,” Dr. Hall explains. “We are the only centre in Canada with a formal training program for practicing physicians who want to become proficient in both basic and advanced emergency ultrasound. Almost every month physicians throughout Canada, even as far away as Ethiopia, come to learn from our Master instructors and become certified. Presently, there is a 6 to 8 month waiting list.”
Recently, 20 emergency physicians from across Canada participated in a 2-day workshop at the Brantford General learning how to use portable ultrasound machines. With both real patients and patient simulators, they learned leading edge applications for point-of-care ultrasound including assistance in managing trauma and shock patients, diagnosing ocular conditions, guiding procedures such as joint aspiration, spinal taps, nerve blocks and fracture management.
Dr. Hall travels extensively across the country and around the world teaching point-of-care ultrasound. And soon a book he is co-authoring will be published.
“I am one of seven emergency physicians working on a book that will be published soon,” Dr. Hall says. “The book is a ‘nuts and bolts’ simple, easy to understand approach to portable ultrasound that emergency physicians can use in their practice. It has been two years in the making and involves feedback from the training of close to 8,000 emergency physicians in basic and advanced emergency ultrasound.”
Dr. Hall talks about always taking a ‘pearl of wisdom’ from continuing education courses he attends, but adds that when physicians take the portable ultrasound course they can practice what they learn very quickly because each day there are applications for its use in busy emergency departments.
“I use our portable ultrasound unit probably 6 to 10 times each shift,” he says, adding, “the more you use it the more proficient you become and this leads to using it even more. In the past couple of years advanced applications for portable ultrasound have been developed.”
Beginning this year some medical students are being taught portable ultrasound in their first year, even before they choose their specialty; and for emergency physicians it is now part of their core knowledge.
Dr. Hall quickly adds that portable ultrasound doesn’t replace the various diagnostic choices that as he says, “Will always be there for physicians and patients. Instead, portable ultrasound helps us to better guide the management of our patients in the emergency department.”
Dr. Hall says, “In the ER where time can be critical, a portable ultrasound unit provides almost instant results. Instead of listening through my stethoscope to help me determine if a patient has fluid around their heart, the portable ultrasound actually lets me see it.”
The stethoscope still hangs around Dr. Hall’s neck and all emergency department physicians. But for more and more patients being treated in the BGH emergency department the portable ultrasound unit isn’t far behind.