Dr. Greg Hall knows first-hand the value of the stethoscope that hangs from his neck and the importance of a portable ultrasound unit at his fingertips.
“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,” says Dr. Hall, an emergency physician at the Brantford General Hospital.
Patients in the 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 explains. “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, so using our portable ultrasound, we safely inserted the pacer quickly and stabilized a very 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 patients bedside in hospital ERs.
Dr. Hall recognized the benefits of portable ultrasound technology in the ER setting and before you knew it, Brantford General was at the forefront. Dr. Hall and other emergency physicians at the BGH became certified Master instructors and, over the years, hundreds of their peers have come to the BGH to be trained.
“Today Brantford General is a designated Canadian Emergency Ultrasound Society training centre,” Dr. Hall says. “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 from across Canada, even as far away as Ethiopia, come to learn from our Master instructors in the BGH emergency department and become certified. Presently, there is a six- to eight-month waiting list.”
This week, more than 20 emergency physicians from all across the country are in Brantford participating in a two-day workshop at the BGH, learning how to use portable ultrasound machines. Using both real “patients” and patient simulators, the course will teach these skilled emergency physicians 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 this book that will be published hopefully within the next few months,” 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. The book 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 pretty well each day there are applications for its use in busy emergency departments.
“I use our portable ultrasound unit probably six 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.
“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 those of all emergency department physicians. But for more and more patients being seen in the BGH emergency department, the portable ultrasound unit isn’t far behind.
Gary Chalk is Director of Public Affairs for the Brant Community Healthcare System, a fully accredited, national award-winning healthcare organization, a 2012 Hamilton-Niagara Top Employer and an affiliated teaching site of McMaster University Michael G. DeGroote School of Medicine. Brantford General is a regional acute care health centre and Willett Hospital in Paris is an ambulatory care centre providing urgent care. Follow on Twitter @BCHSYS.