A majority of rural emergency departments in the province of Quebec use point-of-care ultrasound: a cross-sectional survey

Emergency department (ED) point-of-care ultrasound (POCUS) can be performed rapidly
at patients’ bedside. POCUS results can respond to specific and potentially-life threatening
clinical questions. Furthermore, compliance with POCUS procedures improves patient
safety 1], 2]. POCUS is a safe and relatively low-cost technology 1]. For the focused scans often used in emergency practice, the learning curve for POCUS
is not considered steep 1], 2]. Its use improves diagnostic accuracy and timely management of selected urgent conditions
3]. Many international medical associations have already endorsed POCUS as a standard
of care 4], 5] and recommend training in POCUS as part of residency training and continuing medical
education 6]–9].

In 2006 and 2012, the Canadian Association of Emergency Physicians (CAEP) highlighted
the importance of providing 24/7 access to POCUS in EDs nationwide 10], 11]. Despite the CAEP position on POCUS and its potential benefits, the statistics on
actual use of POCUS in Canada are not clear 10], 11]. The literature in this area suggests that POCUS is increasingly taught and used
in academic EDs in Canada 12], 13]. However, with the exception of one recent study conducted in Ontario 14], the use of POCUS in rural EDs has not been studied.

Rural EDs have limited local access to advanced imaging techniques such as computed
tomography (CT) and formal ultrasound, and inter-facility transfers are often required
to pursue diagnostic evaluations 15]–18]. However, inter-facility transfer processes in rural and isolated areas can be costly,
time-consuming and risky for patients and paramedics 19], 20]. POCUS has the potential to improve triage of patients requiring emergency inter-facility
transfers, and to consequently improve access to timely care 1].

According to Flynn et al.14], POCUS is not used to full potential in rural settings in Ontario. Flynn et al.14] reported that only 60 % of their sample of 200 rural physicians had access to a bedside
ultrasound device. Furthermore, only 44.4 % of physicians reported having the necessary
knowledge or skills to perform POCUS. However, over 70 % of the sample stated that
POCUS competence was an essential skill for the practice of rural emergency medicine
14]. The Flynn et al. study is recent and provides essential information; however, the low response rate
(28.4 %) limits interpretation of the results, and further study of POCUS use in rural
settings is warranted. The present study was designed to examine access to POCUS and
potential barriers/facilitators to POCUS use among rural emergency physicians in Quebec.