Introduction to HHUS in Emergency Medicine
The European Federation of Societies in Ultrasound in Medicine and Biology
(EFSUMB) position paper recognises handheld ultrasound devices (HHUSDs) as
valuable tools in emergency care and point-of-care ultrasound (POCUS) (Nielsen et
al. 2019). EFSUMB supports their use for quick diagnostic tasks like identifying
ascites, assessing hydronephrosis, and gallbladder evaluations. However, proper
training is necessary to avoid mistakes from poor imaging techniques.
HHUSDs can improve speed, accuracy, and cost-effectiveness in emergency
settings when used correctly. Despite their advantages in portability and flexibility,
HHUSDs have limitations, such as small screens and lower image resolution, making
them less suitable for more complex diagnoses.
Common Uses of HHUS in Emergency Medicine
HHUSDs are transforming emergency care, especially in time-sensitive and
resource-limited settings, though they cannot entirely replace traditional ultrasound
machines.
For example, Malik stated in a review that HHUSDs are particularly valuable in lung
ultrasound, a use that grew during the COVID-19 pandemic (Malik et al.2021).
These devices showed high accuracy in assessing lung conditions, and their
portability allows for rapid bedside evaluations, which are crucial in respiratory
emergencies.
In addition to lung issues, HHUSDs help distinguish the causes of acute dyspnoea
by quickly identifying whether the problem is cardiac or non-cardiac. They are also
helpful in diagnosing deep vein thrombosis (DVT) and guiding procedures like
central line placements and IV insertions in patients with difficult access.
Moreover, HHUSDs are frequently used in trauma cases for extended Focused
Assessment with Sonography for Trauma (eFAST) exams, which help patient triage
and risk stratification. This capability is particularly useful in prehospital care or
remote areas where traditional imaging technology may not be immediately
available.
Technological improvements in crystal manufacture, increased processing power,
and advanced algorithms also make single-head crystal probes capable of scanning
multiple organs that traditionally require the user to change probes.
HHUS in Medical Education
Beyond clinical applications, HHUSDs are playing an increasing role in medical
education, not only for teaching POCUS to medical students but also for
demonstrations of anatomy and pathology, which are usually only described in
textbooks. These can be viewed in real time on rounds or lectures. Due to their
accessibility and ease of use, they are excellent tools for students to practice and
improve their diagnostic skills.
Various studies have shown that students trained with HHUSDs become more
proficient in performing basic diagnostic exams, such as cardiac, abdominal, and
lung assessments (Haji-Hassan et al. 2023). For example, the University of
California, Irvine, integrated HHUSDs into their curriculum, improving student
confidence and accuracy in identifying anatomical structures (Comstock, 2019).
Institutional Concerns with HHUS
While HHUSDs offer many benefits, several institutional challenges must be
addressed for their effective implementation in healthcare settings.
Image Storage and Sharing
A significant concern is data management. Many HHUSDs store images on cloud-
based platforms or personal mobile/tablet devices, raising issues about patient
privacy and compliance with regulations like HIPAA. Healthcare institutions must
ensure that images are securely transferred to a Picture Archiving and
Communication System (PACS). Since clinicians personally own many HHUSDs,
questions about data ownership and the handling of patient information are critical.
Additionally, the risk of data breaches is higher when images are stored on personal
devices. Hospitals need clear policies on image ownership and secure sharing to
maintain legal and institutional compliance.
Device Security and Disinfection
The portability of HHUSDs also raises concerns about theft and misplacement.
Hospitals should implement security measures like password protection and tracking
software for these devices. During infectious disease outbreaks, such as COVID-19,
HHUSDs proved beneficial due to their easier disinfection than larger machines.
The Future of HHUS in Emergency Medicine
The future of HHUSDs looks promising, with continued advancements in technology,
artificial intelligence (AI), and telemedicine expected to enhance their role in
emergency medicine.
Integration with AI and Telemedicine
AI is expected to become a key feature of HHUSDs, assisting with image
interpretation and standardising diagnostics. AI tools can minimise human error and
make diagnoses more accurate and efficient. Tele-ultrasound, where ultrasound
images are shared remotely for expert consultations, is also expected to rise,
especially in remote or underserved areas.
Expanding Beyond Emergency Medicine
While HHUSDs are currently most common in emergency departments, their use
expands into other fields like internal medicine, primary care, and obstetrics.
HHUSDs can be used for routine pregnancy assessments or evaluating cardiac and
abdominal issues. With the continued integration of HHUSDs into medical education
and technology improvements, these devices are likely to become even more
widespread in various healthcare settings.
Conclusion
Handheld ultrasound devices (HHUSDs) are becoming essential in emergency
medicine, providing portability, quick diagnostics, and cost-effective solutions. While
challenges like data management and security must be addressed, HHUSDs offer
undeniable benefits in improving diagnostic accuracy and medical education. With
advancements in AI and tele-ultrasound, the role of HHUSDs in healthcare is
expected to expand further.
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References
Nielsen, M. B., Cantisani, V., Sidhu, P. S., Badea, R., Batko, T., Carlsen, J., Claudon, M.,
Ewertsen, C., Garre, C., Genov, J., Gilja, O. H., Havre, R., Kosiak, M., Kosiak, W.,
Pilcher, J., Prosch, H., Radzina, M., Rafailidis, V., Rykkje, A., Serra, A., … Dietrich, C. F.
(2019). The Use of Handheld Ultrasound Devices - An EFSUMB Position Paper. Die
Anwendung handgeführter Ultraschallgeräte – Ein EFSUMB Positionspapier. Ultraschall
in der Medizin (Stuttgart, Germany : 1980), 40(1), e1.
Malik, A. N., Rowland, J., Haber, B. D., Thom, S., Jackson, B., Volk, B., & Ehrman, R. R.
(2021). The Use of Handheld Ultrasound Devices in Emergency Medicine. Current
emergency and hospital medicine reports, 9(3), 73–81.
Haji-Hassan, M., Capraș, R. D., & Bolboacă, S. D. (2023). Efficacy of Handheld
Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative
Analysis. Diagnostics (Basel, Switzerland), 13(24), 3665.
Comstock, J. UC Irvine Medical School gifts Butterfly handheld ultrasounds to its whole
class of 2023. (2019). Mobihealth News.
UC Irvine Medical School gifts Butterfly handheld ultrasounds to its whole class of
2023 | MobiHealthNews
Ho, A. M. H., Critchley, L. A. H., Leung, J. Y. C., Lam, P. K. Y., Lee, A. (2015).
Introducing final-year medical students to pocket-sized ultrasound imaging: Teaching
transthoracic echocardiography on a 2-week anesthesia rotation. Teaching and
Learning in Medicine, 27(3), 307–313.
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