CEUS Position Statement on Advanced Applications
The "Recommended Standards" page of our website was written in 2003. It describes emergency ultrasound as being "in its infancy" in Canada. Since only approximately 50% of the 600 emergency departments in our country are currently equipped with an ultrasound system, the statement remains quite apt.
It is the unwavering position of CEUS that Independent Practitioner status is the minimum necessary for safe and efficient emergency ultrasound practice. This provides a structure wherein physicians with various levels of prior experience and training in emergency ultrasound can have their skills objectively assessed. The role of the Society is to provide leadership in this area until emergency ultrasound becomes an integral part of all emergency medicine, family medicine, surgical and critical care residencies. At that point, emergency ultrasound will have truly become "standard of care". It was always intended that, at this point, the Society would surrender its leadership role to the residency programs.
The arrival of advanced applications in emergency ultrasound practice is a natural step in the evolution of this modality. It is the position of the CEUS that the use of these advanced applications should be encouraged. Ultrasound is now an essential part of the armamentarium of any physician working in emergency departments or any other critical care setting. It is clear, however, that advanced applications require greater manual dexterity and image recognition skills than the basic indications.
The CEUS therefore strongly recommends that all physicians wishing to use ultrasound for advanced applications first complete the CEUS Independent Practitioner training program. Any group wishing to introduce advanced applications into their practice should follow the same high standards of the CEUS process, even if this is done in an informal manner. After completion of an advanced applications course, this would include:
- Execution of scans under supervision
- Confirmation of image recognition skills through positive image review exercises
- Ongoing QA/QC by a local leader thoroughly versed in the advanced applications being used in their center.
It should be noted that the learning curves for the various advanced applications are quite variable. Some, such as peripheral vascular access, approach see-one, do-one, teach-one. Others, such as the gall bladder, require as many supervised scans as the basic indications (50) if not more. Pursuing these applications only after obtaining CEUS IP status ensures that the trainee already has well-developed image-recognition skills and a clear sense of the effort required to achieve a high standard of image generation.
Indications for ED U/S:
- Shock
- Trauma
- Cardiac
- Abdominal aorta
- Pregnancy (First Trimester)
- Procedural guidance
- Thoracic
- Deep venous thrombosis
- Biliary
- Renal/Bladder
- Soft tissue
- Musculoskeletal
- Ocular
- Nerve Blocks
APPROVED BY THE EXECUTIVE SEPTEMBER 15TH 2009
