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Portable ultrasonography in mass casualty incidents: The CAVEAT examination
Stanislaw Peter Stawicki, James M Howard, John P Pryor, David P Bahner, Melissa L Whitmill, Anthony J Dean
Stanislaw Peter Stawicki, James M Howard, Melissa L Whitmill, Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, OH 43210, United States
John P Pryor, Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
Anthony J Dean, Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
Author contributions: Stawicki SP, Pryor JP and Dean AJ designed original concept; Stawicki SP, Howard JM and Dean AJ contributed to the literature background search; Stawicki SP, Howard JM, Pryor JP, Bahner DP, Whitmill ML and Dean AJ wrote the manuscript; Stawicki SP, Pryor JP, Bahner DP, Whitmill ML and Dean AJ made critical manuscript review; Stawicki SP, Dean AJ, Whitmill ML and Howard JM contributed to figures and tables; Stawicki SP, Bahner DP, Whitmill ML and Dean AJ contributed to sonographic images; and Stawicki SP, Bahner DP, Dean AJ and Whitmill ML contributed to technique descriptions.
Correspondence to: Stanislaw Peter Stawicki, MD, Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Suite 634, 395 West 12th Avenue, Columbus, OH 43210, United States. stanislaw.stawicki@osumc.edu
Telephone: +1-614-5931973 Fax: +1-614-2939155
Received: August 10, 2010
Revised: October 21, 2010
Accepted: October 28, 2010
Published online: November 18, 2010
Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.
