Considerations for Ultrasound in the Urban Search and Rescue (USAR) Environment

Abstract

Delivery of medical care in the urban search and rescue (USAR) environment poses challenges both to austere providers not just in the complexity of care demanded of them but also in the inherent hazards and limited space environment it usually occurs in. Developed as an organized response system to building collapses from major earthquakes, USAR medicine focuses on patient care in limited space environments coordinated with prolonged technical rescue techniques. Additionally, most USAR medical providers typically do not reach their victim until hours after the initial trauma virtually making every patient encounter a prolonged field care scenario. Clinical conditions such as limb entrapment, crush or compartment syndrome, primary blast injuries and hemorrhagic shock due to blunt trauma common in USAR medicine. As ultrasound technology has gotten better and smaller, the feasibility of performing ultrasound in the confined space to guide patient care has become a reality. Emergency ultrasound applications such as eFAST, pulmonary applications specifically for the identification of pulmonary edema in primary pulmonary blast injuries or guiding volume resuscitation, assessment of limb perfusion, intravenous access and identification of long bone fractures are now all possible. More recently, USAR teams have become more involved with wide area search as well as water rescue operations resulting in providing general medical and trauma care in resource depleted environments such as those post-hurricane. Ultrasound has more general applicability as in any forward urgent care center or medical aid station. The use of ultrasound in this environment must be tempered with the understanding that additional clinical data can complicate the medical decision-making process if not applied in the appropriate clinical setting.