The ultrasound portable machine used in the Afghanistan: an international experience

Purpose: In hostile environment and battlefield US (ultrasound) portable machine and the application of EFAST (Extended Focused Assessment with Sonography for Trauma) have become useful and necessary diagnostic tools. The high sensibility and specificity of new US scanners to detect, in a patient with trauma both internal haemorragies and pneumothorax in a very early stage (before any clinical sign appears) let to a precise evaluation of patient condition and drive to appropriate surgical or conservative treatment.

Material and methods: Italian and USA experience: From April to October 2008 in Afghanistan in a United States Role 2 (First Aid with operating facilities) 32 over 67 wounded (by gun shot or explosion device) have undergone EFAST with a handle US scanner. 4 were positive for hemo-pneumothorax. 1 positive for hemo-pneumothorax and abdominal haemorrhagies and 1 for hemo-pneumothorax and cardiac tamponade.

Spanish experience: from September to October 2012 in Afghanistan in a Spain Role 1 (First Aid) 17 over 26 wounded (by gun shot and explosive device) have undergone EFAST with a handle US scanner. 5 of them were positive for abdominal haemorrhagies.

Results: The experience of NATO Forces has shown the efficacy and necessity of using US scanner on battlefield used by well trained personnel. This tool has given proper evaluation without wasting time and driving medical providers in the choice of treatment. US has to be integrate in Tactical Combat Casualty Care protocols to give an evidence about internal haemorrhages and to rule out any pneumotorax from the very first moment.

Conclusion: Us must be considered part of clinical examination for all traumatic patients in hostile environment and battlefield. This tools can detected haemorhaggies before any clinical sign evidence. US is also useful to evaluate no traumatic medical condition that could affect a soldier in a remote post needing an helicopter evacuation.