Thinking traditionally we need practice and exposure to remain proficient at point-of-care ultrasonography (POCUS). As many have pointed out this can be challenging for a SOF Medic, who already has 17 other jobs to think about… The thing is… Rather than dwelling on the skill sustainment problem, we should be focusing on the skill-support solution.

Thanks to rapidly evolving technology, we can offer remote tele-supervision:

  • during training &
  • in the patient-care settings.

It is neither costly nor technically challenging. As research has shown, a low-cost smartphone can be successfully applied to guide even the ultrasound-naive examiners. And that is why we suggest that adding tele-supervision to the sono flipped classroom could be the way to deliver high-volume ultrasound training. We should also consider tele-ultrasound guidance, to assist the SOF Medics with:

  • image acquisition
  • image interpretation
  • medical decisions that follow.

Tele-ultrasound could be the answer to the “skill maintenance concerns”. It’s about maintaining familiarity rather than sustaining proficiency. If after 2 hours of training, the International Space Station non-physician crew members can be remotely guided though a number of sono exams, we can surely support our SOF Medics operating on other continents. 

The following forms of remote POCUS consult can be offered:

  • REAL-TiME GUiDANCE: a remote consultant follows the screen and the operator’s hand movements.
    • Advantages:
      • Guidance though scans one has never done before;
      • Fine-tuning of images;
      • Procedural guidance;
      • Interpretation and medical-decision making support;
      • No need to transmit large video-files with ultrasound clips.
    • Disadvantages:
      • Potentially lower quality of images (e.g. screen watched through a camera);
      • Operator motion;
      • Requires on-site Internet connectivity.
  • AFTER THE FACT REViEW of images and clips:
    • Advantages:
      • Does not require on-site Internet access – high quality images and clips can be sent after the fact  as e.g. .jpeg and .mp4 type files respectively. Unless one is diagnosing pericardial tamponade, tension PTX or performing a procedure, most other scans still have clinical value to the patient, even if the review and consultant recommendations are somewhat delayed;
      • Great teaching tool – receiving feedback is a great way to improve one’s skills;
      • Saved images and clips can be used for credentialing, QA/QI, publications and education.
    • Disadvantages:
      • Sending large video-files can be time-consuming;
      • Video clip transmission requires a fairly high-speed Internet connection;
      • Additional images or clips cannot be requested;
      • Scanning technique cannot be corrected to facilitate interpretation. 

SOFsono fun admiralMoving forward we should strive to STANDARDiZE the LiNGO of TELE-ULTRASOUND used in special ops medicine. In order to keep the remote POCUS consults smooth and easy, we must ensure that expressions such as sliding, rotating, tilting/fanning, rocking, etc. are well understood by all the parties involved. 

If you are interested in this topic, here you can find a number of pertinent publications. Setting up a basic TELE-ULTRASOUND SYSTEM is actually quite cheap and easy. Military grade comms infrastructure could possibly improve the quality of images and clips transmitted, however, it sounds like a simple FaceTime session can do the trick as well. 

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