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EMS STATE OF THE SCIENCES CONFERENCE: REPORT FROM THE GATHERING OF EAGLES 54 JUNE 2015 | EMSWORLD.com with extended PEA. If we could look and find additional signs to support continued care, we could better serve the patient. We could change methods and pharmaceuti- cals to be more appropriate to the patient's needs." Another condition where being able to image the heart movement with ultrasound would be useful is in what Harrell called really, really fine asystole. "Ultrasound offers huge opportunities to make better treatment decisions," he said. Harrell cited a 2010 study from Henne- pin County, MN, where paramedics were trained in FAST and aortic aneurysm ultra- sound examination techniques in a six-hour course. During the study, 104 patients who were being transported for cardiac condi- tions were examined by paramedics dur- ing transport, after all other emergency care was provided. Follow-up reading by physicians agreed with 100% of the med- ics' exam interpretations. Most important, according to Harrell, was that pericardial fluid was found in 7% of the exams, poten- tially leading to altering patient care. "That study shows there certainly is an opportunity. The results speak volumes to the fact that it's technically doable in the field and trainable for field use," Harrell said. A 2014 survey of National Association of EMS Physicians EMS medical directors showed 22% of respondents considering using ultrasound in the prehospital setting. Harrell said the devices are becoming more durable and cost-effective, which adds to the allure. "When we can get more than one device that can be used over and over for less money than a single heart monitor, it really changes the calculus for EMS sys- tems," he said, adding that one day we may look at ultrasound the same way we once did pulse oximetry and AEDs. Harrell said it is important to keep look- ing at patient care, emerging technologies and how we can use technology to improve patient outcomes. "Right now we don't even know what we don't know," he said. "Can ultrasound be taught and fielded successfully? Let's find out. We own pre- hospital cardiac arrest. This is what we do. These are the patients on whom we are most likely to make the most difference." Presentation: TEE-ing Off the Cardiac Arrest Sand Trap: Shadow-Boxing for CPR Vectors, Missed VF & Pseudo PEA. Present- ed by Scott T. Youngquist, MD, MSc, Medi- cal Director, Salt Lake City Fire Department. SCOTT YOUNGQUIST, MD, MSC, is medical director for the Salt Lake City Fire Department. He has been examining the potential for prehospital use of a different type of ultrasound technology: transesoph- ageal echocardiography (TEE). His Gathering of Eagles presentation was titled "TEE-ing Off the Cardiac Arrest Sand-Trap: Shadow-Boxing for CPR Vectors, Missed VF & Pseudo PEA." It discussed how using TEE to directly visualize the heart during cardiac arrest might address some limitations of field assessment and treatment. What impact would there be if prehospital providers could, in effect, see structures and movement inside the body? Youngquist said the idea came as a result of work Mike Mallin, MD, did developing an emergency ultrasound program at the University of Utah. Youngquist said he has a strong interest in both echocardiography and cardiac arrest treatment. "We use TEE in the emergency department," he asks. "Why can't we use it in the field?" TEE is a test that uses sound waves to create high-quality moving images of the heart and its blood vessels. A flex- ible tube is inserted down the patient's throat into the esophagus. A transducer at its tip generates images that show the size and shape of the heart, as well as how the chambers and valves are working. TEE can identify areas of heart muscle that are not working properly and detect possible clots, pericardial fluid buildup and prob- lems with the aorta. Because the esopha- gus is directly behind the heart, highly Transesophageal Echocardiography By Ed Mund TEE during CPR