Diagnostic Accuracy of Extended Focused Assessment with Sonography for Trauma Performed by Paramedic Students: A Simulation-Based Pilot Study

BACKGROUND: Training on how to perform a prehospital extended focused assessment with sonography in trauma (EFAST) has resulted in improved outcomes for trauma patients in several countries. The result of previous studies showed good accuracy despite minimal training. However, data on the diagnostic accuracy among untrained paramedic students and the course length in middle-income countries is scarce. In Thailand, the current paramedic education does not include training on prehospital ultrasounds. In the present study, we aimed to investigate the diagnostic accuracy of EFAST among ultrasound-naïve paramedic students and factors that are associated with successful posttest training. METHODS: Final-year paramedic students attending a 4-year university program were included in this study. A 2-h didactic training session and 1-h hands-on workshop were led by experienced emergency physicians. The diagnostic indices for EFAST interpretation were obtained pretraining and posttraining. The participants’ ultrasound image acquisition was also evaluated individually on a mannequin model using a standardized assessment tool. RESULTS: In total, 47 paramedic students were voluntarily enrolled and underwent EFAST training. Of these participants, 31 (66%) reported having >1 year of experience in the prehospital field. Four were advanced emergency medical technicians before becoming paramedic students. The sensitivity, specificity, positive predictive value, and negative predictive value after training were 85.7% (95% CI, 81.5–89.3), 81.6% (95% CI, 74.2–87.6), 91.6% (95% CI, 87.9–94.4), and 71% (95% CI, 63.3–77.8), respectively. Previous prehospital experience was not associated with accuracy. CONCLUSION: This study demonstrated that paramedic students in Thailand were able to achieve a competency comparable with that of other medical professionals in a simulated environment. The total 3 h training course was sufficient for them to acquire EFAST skills.