Training of Emergency Physician Sonographers

Review of published literature shows that there is no agreed training schedule, with programmes varying widely, from one hour lecture and one hour practical training, to over 500 supervised scans [10-12].  Shackford et al. (1999) suggested that the error rate fell from 5% (from an initial rate of 17%) and stabilised after 10 scans. [13]

In a retrospective review of 100 patients with blunt abdominal trauma in England, FAST had a specificity of 94.7% (95% CI: 0.75–0.99) and sensitivity of 46.2% (95% CI: 0.33–0.60). Positive Predictive Value of 0.96 (0.81–0.99) and Negative Predictive Value of 0.39 (0.26–0.54). Fisher’s exact test shows positive FAST is significantly associated with Intra-abdominal pathology (p = 0.001). Cohen’s chance corrected agreement was 0.3. 21 out of 28 who underwent laparotomies had positive FAST results indicating accuracy of 75% (95% CI: 57%–87%) [14]

Branney et al. (1995) [15] demonstrated that small quantities of fluid (as small as 225 ml) can be detected, but 85% of sonographers will be detecting 850 ml. Therefore, in regard to detecting free fluid, there was no difference between emergency physicians, surgeons or radiologists.