Soundwaves of innovation: a qualitative exploration of POCUS in Australasian ambulance and retrieval services.

Abstract

Objectives: Point-of-Care Ultrasound (POCUS) represents an advancement in diagnostic ability and procedural success for paramedics in out-of-hospital settings. Despite its potential to rapidly identify life-threatening conditions and improve patient management, the adoption of POCUS faces multiple challenges, including the need for standardized training, credentialing, and robust governance. This study aims to evaluate the current use of POCUS by paramedics in Australasia, focusing on training, credentialing, governance, and auditing systems. It also explores the main barriers and facilitators that influence its effective integration and operational effectiveness in out-of-hospital environments.

Methods: This qualitative study utilized reflexive thematic analysis following Braun and Clarke's methodology to capture deep insights into POCUS usage. Participants included medical directors and clinical leads from jurisdictional ambulance services and retrieval services across Australasia. They were selected via purposive sampling and interviewed using semi-structured techniques, which allowed for an in-depth exploration of their experiences and perceptions related to POCUS.

Results: Four major themes were identified: (1) Pillars of POCUS: highlighting the necessity of robust governance, education, and infrastructure for effective POCUS programs; (2) System Buy-In: emphasizing the need for medical and institutional support to maximize the benefits of POCUS; (3) Culture Change in Paramedicine: discussing the shifts required in paramedic practices and attitudes towards adopting new diagnostic technologies; and (4) What's the Worth: evaluating the cost-effectiveness and value of POCUS in the face of budget constraints and its potential to improve patient outcomes.

Conclusions: The study underscores significant disparities in POCUS training and a lack of standardized governance across Australasian services, which are major impediments to its adoption. Additionally, financial considerations and the perceived value of POCUS impact its acceptance and expansion. To fully leverage the capabilities of POCUS in enhancing paramedic practice, development of comprehensive, standardized frameworks addressing these challenges is essential. Future efforts should focus on demonstrating the economic and clinical benefits of POCUS to support its widespread adoption in emergency medical services.