Augmenting the Utility of Ultrasound in Mounting an Effective Public Health Response during Disasters

Dear Editor, Disasters, be they natural or man-made, pose major challenges to public health by disrupting healthcare delivery systems, straining available resources, and impacting quality of life.[1] These disasters disproportionately affect vulnerable population groups, such as women, children, and the elderly, especially in low-resource settings, by interrupting access to essential healthcare services.[1] Ultrasound technology has a special role in the effective management of disasters, owing to its portability, ability to provide immediate diagnostic results, noninvasive nature, and cost-effectiveness.[2] The findings of an article about a 7.3 magnitude earthquake in China in 2013 reported the utility of portable ultrasound in facilitating the on-site quick screening of victims, as 38 patients were diagnosed with multiple sonographic findings (such as abdominal-free fluid, mild pericardium effusion, pneumothorax, and collapse of inferior vena cava) in the initial 48 h after the earthquake.[3] The utility of handheld ultrasound was also evident in Guatemala after a natural disaster when 99 patients were screened using the tool, and multiple traumatic injuries were identified involving different organs.[4] Further, it can significantly aid in prioritizing treatment for critically injured patients (triage) and also can be merged with telemedicine to enable remote consultation and diagnosis by specialists during disasters.[1,5] Regardless of the wide range of ultrasound applications in disasters, their utility is influenced by multiple challenges that must be overcome to optimize its effectiveness.[1,2,5-7] We must acknowledge that the availability of trained personnel who can operate and interpret findings precisely, especially in disaster-affected regions, is limited.[6] As the accuracy of ultrasound depends on the skills and experience of the operator, there is an immense need to strengthen the training component. This shortage of trained personnel can be overcome by training healthcare workers in easy-to-understand training programs, including simulation-based training to provide hands-on experience.[6] In addition, the option of tele-ultrasound can be explored to help less experienced operators in diagnosing the condition.[5] The next challenge is the problem of transportation of portable devices to remote or disaster-hit locations, including maintaining a reliable power source for extended periods.[7] This concern can be handled by placing devices in predefined locations in disaster-prone zones so that they are readily available whenever needed without much delay. Further, investments can be made to design portable devices that are lightweight and can be operated on either battery or solar power when power supplies are not available.[1,2,7] In most disaster settings, a certified disaster medical team is competent in managing power problems but may still face challenges under exceptional circumstances. Moreover, practical (like many patients in mass casualty that need attention) constraints can also limit the utility of ultrasound in disaster settings.[1] This challenge requires that during massive disasters, the use of ultrasound is primarily only for triage purposes to identify critical patients that require immediate interventions.[1] Further, specific protocols should be developed to guide operators to perform quick assessments without compromising the work quality. Finally, ultrasound has limited potential in diagnosing many conditions (such as intracranial injuries and complex fractures), and these situations warrant the use of additional imaging modalities for arriving at the correct diagnosis.[1] This calls for the need to train emergency responders on the limitations of ultrasound and under what situations it should be complemented with other diagnostic tools.[1,6] In conclusion, ultrasound as a diagnostic tool has immense scope in disasters to mount an effective health response. However, the utility is limited by some challenges, which will require targeted training, better logistics, and robust devices to maximize the effectiveness in disasters. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.