Tele-guided lung ultrasound may be acceptable to specialist paramedic trainees following brief training, although challenges could present barriers to wider implementation.
The mixed-methods interventional study included nine registered, practicing paramedics enrolled in specialist postgraduate courses. Participants completed a 1-hour online lung ultrasound module and about 3 hours of supervised practical scanning prior to performing lung ultrasound examinations on healthy volunteers with real-time guidance from expert sonographers in another room. The 6-point Usage Rating Profile–Intervention Revised (URP-IR) evaluated acceptability, understanding, feasibility, and system climate and support. Free-text responses were also analyzed to identify perceived facilitators and barriers.
Overall acceptability was rated 5.37 and feasibility was rated 5.51. Interest in implementation and commitment to implementation each received a mean rating of 5.89. The participants rated both manageable time requirements and reasonable material resources 5.44 and minimal preparation 5.67.
Ratings were lower for factors related to implementing tele-ultrasound within the broader work environment. The overall system climate rating was 4.91, including ratings of 4.44 for manager support and 4.56 for consistency with current practices. System support was the lowest-rated domain at 4.56, reflecting perceived needs related to resources, professional development, and additional support.
The qualitative analysis identified three key categories: improved diagnostics, equipment reliability, and standardized terminology. Over 50% of the participants identified equipment reliability and technical issues as the main implementation barrier, citing connectivity problems and equipment faults. They recommended consistent terminology and standardized work instructions covering setup, probe positioning, and anatomical landmarks to improve communication between paramedics and remote sonographers.
Communication posed a challenge because of the tele-ultrasound setup. Although the system transmitted images and videos, the remote sonographer could not directly see the transducer position or the patient. Incorrect probe orientation could therefore go unnoticed and delay correction. They identified standardized terminology, stepwise protocols, and closed-loop communication as potential approaches for addressing these challenges.
Equipment reliability was another implementation concern. The investigators noted that effective tele-ultrasound depended on connectivity and device performance to transmit high-resolution imaging and avoid delays. However, most technical issues were related to unfamiliarity with the software rather than device faults. Additional training and basic troubleshooting could help address these challenges in future research.
The findings were limited by the small and potentially selected sample. Although 16 eligible participants completed the consent process, just nine attended the workshop. The investigators noted that recruitment and nonattendance may have preferentially included participants with greater interest in ultrasound and technology, potentially biasing acceptability estimates upward. The participants also performed scans on healthy volunteers rather than patients with lung pathology, limiting clinical generalizability. The investigators did not evaluate operational conditions such as variable connectivity, environmental noise, patient distress, and time-sensitive decision-making.
"[O]ur findings [...] [provide] acceptability data in paramedics and identify implementation-relevant barriers that can inform future out-of-hospital-focused evaluations," wrote lead study author Angus Bowden, of the Department of Paramedicine in the Faculty of Medicine Nursing and Health Sciences at Monash University, and colleagues.
The study authors declared no conflicts of interest.
