By Lawrence A. Melniker, MD, MS, FACEP
In 1999, in response to Resolution 802 introduced by the American College of Emergency Physicians and the American College of Obstetricians and Gynecologists, the American Medical Association House of Delegates passed the following:
Resolved that our American Medical Association (AMA) affirm that ultrasound imaging is within the scope of practice of appropriately trained physicians; and be it further
Resolved that AMA policy on ultrasound acknowledge that broad and diverse use and application of ultrasound imaging technologies exists in medical practice; and be it further
Resolved that AMA policy on ultrasound imaging affirm that privileging of the physician to perform ultrasound imaging procedures in a hospital setting should be a function of hospital medical staff and should be specifically delineated in the department's Delineation of Privileges form; and be it further
Resolved that AMA policy on ultrasound imaging state that each hospital medical staff should review and approve criteria for granting ultrasound privileges based upon background and training for the use of ultrasound technology and ensure that these criteria are in accordance with recommended training and education standards developed by each physician's respective specialty society.
Since that time, great strides have been made in research, administration, and quality management of POCUS in emergency medicine and several other specialties are moving to expand their use – the paradigm is shifting! Two important elements of this transformation in physical medicine are the introduction of integrated, vertical ultrasound curricula in many sites of undergraduate medical education and the development of “Sono-First” diagnostic protocols; in which the initial imaging modality is ultrasound, in order to mitigate radiation exposure.
The Society for Ultrasound in Medical Education (SUSME) held its 4th World Congress in September and most North American as well as several international Medical Schools were represented. Additionally, SUSME and the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) have convened the 1st International Consensus Conference on Ultrasound in Medical Education, chaired by Richard Hoppmann, MD. [http://www.wcume.org/]
Investigations of “Sono-First” protocols have found, under appropriate clinical conditions, ultrasound offers clear safety advantages over radiation-emitting imaging, especially in the pediatric population. Yet ultrasound remains underutilized with many clinicians unaware of the range of conditions for which Sono-First is recommended. This detrimental lack of understanding and buy-in grows larger as research further evidences ultrasound's diagnostic value. Radiation mitigation is an increasing concern and Sono-First protocols are a proven methodology to reduce exposure. [http://www.ultrasoundfirst.org/]
At ACEP16 in October, the crafting of two new resolutions was proposed and agreed upon by the AMA Section Council on Emergency Medicine. The first will call for AMA endorsement of 4-year integrated, vertical curricula in all centers for undergraduate medical education. The second, calling for endorsement of the development and promulgation of Sono-First protocols in order to mitigate medical radiation exposure. These resolutions will be drafted with the input of others with experience in resolution writing at ACEP and the AMA. Anyone wishing to participate in the drafting is welcome to contact Section leadership and myself via email. Final versions will be presented to the membership through the e-list for comment.