The American College of Emergency Physicians is a member organization of the CAAHEP, and for a good reason. Emergency ultrasound is recognized across medical specialties as a means for bringing sonographic imaging to the patient in the emergency room or clinic where quick diagnosis is usually critical. General and specialist physicians are completing the core curriculum of accredited sonography programs because the emergency ultrasound training will lead to greatly improved patient care.
Credentialed Physicians
In 2009 the Society for Diagnostic Medical Sonography published an article titled “Sonography in the ER” to discuss the growing role of emergency ultrasound in delivering more effective patient care. At the time, emergency medicine physicians were already choosing to complete a core curriculum in sonography as part of their residency program. The SDMS pointed out that the use of ultrasound imaging in the emergency room was exploding as sonography was used for diagnosing a greater number of medical conditions.
Emergency ultrasound is not a separate program or a specialization as of yet, meaning there is no separate credentialing for the emergency ultrasound healthcare provider. That may change in the future. Currently the only physician-specific ARDMS credentialing is for the Registered Physician in Vascular Interpretation (RPVI).
As of now, emergency ultrasound training usually refers to the addition of sonography training as a component of physician training. However, the physicians completing the training are focused on the use of sonography at the patient’s bedside, using the latest advances in portable ultrasound equipment. The most comprehensive training has the same requirements as a CAAHEP accredited sonography program in that it requires didactic and clinical training. Ideally, the program is CAAHEP accredited so that the courses are assured of meeting minimum standards. In fact, many emergency room physicians are earning ARDMS credentials by qualifying for and passing ARDMS registry exams.
Physicians who have already completed their residency training and are practicing emergency room doctors may decide to take a relevant emergency medicine ultrasound course. The American College of Emergency Physicians (ACEP) has developed training and credentialing guidelines for practicing physicians interested in incorporating ultrasound into their skills base. Some hospitals offering residency training will bring a commercial course to their location to make access as simple as possible. Any course offered to physicians should meet the minimum ACEP guidelines.
Ultrasound Assumes Larger Role in the Emergency Room
Physicians using emergency ultrasound are focused on identifying the specific emergency medical condition that needs immediate treatment. This is a different focus from ultrasound delivered by sonographers on a daily basis in hospitals or clinics. Despite the fact the emergency room doctor is using ultrasound with a more limited scope, the physician is also dealing with a variety of unknown medical conditions that need quick identification. Sonographic images are used for conditions related to:
- The abdomen
- The cardiovascular system
- Trauma
- The pelvis
- The eyes
- Obstetrics
- Musculoskeletal injuries or conditions
- Soft tissue injuries
The American College of Emergency Physicians (ACEP) named five major reasons for using emergency ultrasounds:
- For acute resuscitation
- Based on patient symptoms
- To diagnose
- For therapeutic reasons or physiological monitoring
- To support or guide a medical procedure
Emergency Ultrasound a Growing Discipline
Hospitals and clinics have many reasons for encouraging or requiring physicians to complete ultrasound training. They include offering the highest quality patient care, lowering the cost of health care services, increasing the speed and accuracy of emergency treatment, and ensuring ultrasound services can be provided at all times.
Emergency ultrasound is a broader discipline than the name implies. The emergency ultrasound jobs are found in hospitals, clinics and private specialty practices. The American Board of Emergency Medicine also approved a new physician specialty in hospice and palliative medicine in 2006. This specialty often delivers bedside ultrasounds in a variety of settings that include nursing homes, hospices and private homes.
Emergency ultrasound is a concept that is rapidly expanding as technology advances. As the equipment gets smaller and more mobile, it is being used in pre-hospital settings also. Sonographers (not physicians) are training as emergency technicians and joining health care teams on emergency helicopters and in ambulances. There are many situations in which ultrasound can be used for monitoring and screening, such as in the case of the fetus exam or cardiac arrest.
Karen S. Cosby and John L. Kendall wrote the emergency ultrasound book titled “Practical Guide to Emergency Ultrasound” (2014, Lippincott Williams & Wilkins), and it provides an in-depth discussion of the topic.
Though emergency ultrasound has been recognized for many years, it remains an emerging discipline. It is likely that continued technology advances producing even more portable machines that are easy to use will eventually lead to sonographers delivering the emergency ultrasound scans while assisting ER physicians in and out of hospitals. It is also predicted that emergency ultrasound training will one day become a required core curriculum course in sonography programs.