Radiology

Type 2 and 3 have basic X-ray and ultrasound capabilities and form part of a referral mechanism for facilities lacking such services.

Diagnostic imaging provided by EMTs should comply with minimum safety standards for both technician and patients.48 In particular, EMTs must comply with the standards of justified practice regarding the procedure’s benefit outweighing the risk, minimizing doses to staff and patients and maximizing safety through shielding and well-maintained equipment. When demand is high EMTs should have a system that considers the appropriate fulfilment of imaging and triaging requests.

1. Provide plain radiography capable of imaging limbs, chest, pelvis and spine in a dedicated X-ray space identified on camp layout maps.
2. Locate the space peripherally on the hospital site but with access to acute patient areas and considered in patient flow.
3. Establish safety requirements such as a cordoned off safety area surrounding the X- ray tent with adequate signage and distance from the source of exposure and wear lead gowns.
4. Ensure the X-ray technician is a qualified and trained practitioner (usually a radiographer, some teams may have a clinician with the appropriate licence).
5. Comprehend preventive maintenance procedures, trouble-shooting techniques, and how to use the equipment in an austere environment.
6. Consider provision of radiography services for emergency out of hours requests. Identify each study taken at minimum with the date of the study, patient identification, identification of the facility and initials of the technician who performed it.
7. Ensure a formal patient identification check, explanation of the procedure and verbal patient consent for each examination.
8. Consider the risk of pregnancy (for X-ray) and include it in any imaging protocol.
9. Provide all patients, at a minimum, a paper printout of their images and a written clinical interpretation in their discharge paperwork.

Type 3

• • Ensure there is a clinician on the team competent in eFAST scanning.

1. EMTs are encouraged to extend their ultrasound capability above minimum standard by having clinicians experienced in an undifferentiated shock protocol, obstetrics and gynaecology, difficult IV placement, regional blocks, foreign body identification and fracture alignment. Portable ultrasound equipment for medical care is efficient, professional, reliable and helps make better decisions.
2. Although Type 1 teams are not required to provide any radiological investigations, if they have a clinical capability to use ultrasound, it can improve decision-making in acute trauma (and other presentations) and triaging of patients for transfer to higher levels of care.
3. EMTs may be in a position to donate their imaging equipment once a careful needs analysis has been undertaken and in accordance with the WHO Medical Device Donation Guidelines.49 When donations are considered, careful attention is required due to complex matters such as specialized training, professional installation, compliance with safety regulations and need for specialized maintenance support in the field. Training and spare parts should be provided either remotely or on-site after donation.
4. Establish a remote support system to discuss difficult cases with a qualified radiologist by videoconference or for technical issues with equipment failure or maintenance when not available on-site.

• Most reporting and interpretation of imaging in the acute emergency is performed by non-radiologist clinicians. Large teams may include a radiologist for this function.
• EMTs using digital film have to consider how to print or download a copy of the patients X-ray or ultrasound image onto a digital carrier for further patient follow up.