Most college classes don’t involve checking the health of students’ lungs.
But the Wednesday morning paramedicine lab at Santa Fe Community College’s Emergency Medicine Services Institute was not most college classes.
As student Logan Luiz sat on a gurney, instructor Drew Congdon pressed a gel-coated ultrasound wand against Luiz’s chest, fitting it into the space between two ribs. About 20 students — all about halfway through the college’s one-year paramedic program — gathered around as a cloudy, black-and-white image appeared on Congdon’s iPad.
There were Luiz’s ribs, glowing white on the screen and casting shadows deeper into the ultrasound. And there was Luiz’s pleura — the membranes surrounding his lungs — sliding back and forth with each breath. False echoes of the pleura called A lines appeared horizontal on the screen, a sign of healthy lungs.
“You’re going to be all right, Logan,” joked Sean Callin, another instructor.
Although ultrasounds are best known for their role in obstetrics — for producing sonogram images of fetuses — they can be used to get a better view inside the body in all sorts of medical contexts, including emergency medicine, Congdon explained to his students.
Emergency services providers using ultrasounds in the field is not new, Congdon said; the technology has been been in use for at least 20 years in Europe and inside some American ambulances for about a decade. But the technology is new to Santa Fe Community College.
Wednesday’s class marked the first time students in the paramedicine program learned how to use portable ultrasound technology to better diagnose and treat patients in the field, said Samantha Barela, the program’s lead instructor.
Here’s how the technology works: Ultrasound probes send out sound waves, which bounce off structures in the body and reflect back to the probe where they’re converted into an image, Congdon told his students. The technology can visualize body systems as shallow as veins and arteries less than 3 centimeters under the skin to the center of the chest cavity, 16 to 20 centimeters deep.
That imaging is helpful in a variety of emergency medical contexts. Although the students first tried out the technology on lungs, the equipment will reappear in later units in the program, as students learn about cardiac, obstetric, trauma and other forms of medical care, Callin said.
These days, ultrasound equipment can be as portable as connecting a probe to an iPad or iPhone, making it accessible and useful for emergency medical service providers.
“This is what’s made ultrasound really possible for the pre-hospital world,” Congdon said, holding up a sample probe.
Because paramedics can transmit field ultrasounds to emergency room physicians and others involved in hospital care, the technology also makes things easier on the hospital side too, Barela said.
“It really is a tool not just for us but for the overall care of the patient,” she said. “Then, they can take that ultrasound and it stays in the patient’s record. It goes with the patient.”
Ultrasounds are not meant to replace paramedic essentials, Barela clarified; students should still plan on listening to patients’ lungs using stethoscopes and performing other standard checks before pulling out the probe.
Where ultrasounds are helpful, though, is to confirm a particular ailment and treatment plan when presented with multiple possible options, Congdon said. He demonstrated how ultrasounds can show the difference between a collapsed lung, fluid in the lungs or pneumonia.
“This is really going to help you with that gray-area patient — which a lot of our patients are. … It’s really going to help you find your treatment plan,” Congdon said.
This is particularly important in respiratory cases, said Forrest Joy, a student and current emergency medical technician for the Santa Fe County Fire Department who will join the department’s ranks as a paramedic upon completion of the course.
“Respiratory patients can be difficult because certain treatments can be very effective, but you need to be 100% sure of what you’re treating. If you’re wrong, you can actually do harm to the patient,” Joy said.
When he’s in the field, Joy said, ultrasounds will help him choose the right treatment option for his patients.
His lungs freshly probed, Luiz envisioned how he could apply the ultrasound technology to the incident that inspired him to become a paramedic in the first place.
An avid climber, skier and river guide, Luiz hopes to apply his paramedic training as a wilderness first responder; he’s already tried out remote emergency care as a ski patroller.
During his rookie year on ski patrol, Luiz said he was first on scene to treat a badly injured man suffering from an aortic dissection, a tear in the body’s main artery.
“It’s go time,” Luiz recalled his supervisor saying as they readied the patient for a helicopter evacuation.
The experience made him realize he wanted to work in a fast-paced, high-intensity work environment — somewhere where it’s always “go time.”
Reflecting on the experience Wednesday, Luiz imagined using an ultrasound to examine the tear in the man’s aorta.
“If we’d had the ultrasound, we would have been able to totally visualize everything that was happening,” Luiz said. “The more we know as [emergency medical services] professionals, the better we can respond and the better our interventions can be.”
Luiz thinks the Santa Fe Community College course will familiarize him with the techniques and technology necessary to succeed as a paramedic.
“I want to be able to help people as best I can, and this class is giving me the skills to do that,” he said.