UUSSLLSS BBLL11 ~~ PPRROOVVIIDDEERR

UULLTTRRAASSOOUUNNDD

LLIIFFEE SSUUPPPPOORRTT 'USCMC LEVEL 1’ CERTIFICATION SKILL SET

ENTRY COURSE FOR ‘USLS BL1-P’ [ULTRASOUND LIFE SUPPORT - BASIC LEVEL 1 - PROVIDER]

AABBCCDDEE UULLTTRRAASSOOUUNNDD

RREESSUUSSCCIITTAATTIIOONN

2211--2222 OOccttoobbeerr 22001133

~~ TTookkyyoo ((JJaappaann)) ~~

VVeennuuee

www.winfocus.org

CCOOUURRSSEE DDIIRREECCTTOORR

Enrico Storti (Milan, Italy)

CCOOUURRSSEE FFAACCUULLTTYY

Vito Cianci (Arzignano, Italy)

Carmela Graci (Milan, Italy)

Adi Osman (Kuala Lumpur, Malaysia)

Luca Neri (Milan, Italy)

WWIINNFFOOCCUUSS CCOONNTTAACCTTSS

Secretariat Office

NOEMA

Via Orefici, 4 - 40124 Bologna, ITALY

Tel +39 051 230385

Fax +39 051 221894

secretariat@winfocus.org

www.winfocus.org

““ CCRRIITTIICCAALL UULLTTRRAASSOOUUNNDD”” The concept of 'critical ultrasound' evolved recently from 'emergency ultrasound' performed at the 'point-of-care' in scenarios such as emergency departments, ICUs, pre-hospital care, austere environments, disaster scenes, tactical operations, and humanitarian care missions. Clinical scenarios turn into 'critical' ones when there is a dangerous performance gap between the patient status and the resources available for an appropriate decision making and problem solving. In such settings ultrasound point-of-care image acquisition and interpretation, integrated with advanced life support protocols (ACLS, ATLS) according 'ABCDE' and 'Head-to-toes' -type approaches, allows for rapid and effective decision making, enhanced triage, diagnosis, therapy, monitoring, and follow up. Nowadays, that’s approach is also known as ‘Ultrasound Life Support’. This typically occurs in the acutely ill patient (Emergency US) or intensive (Intensive/Critical Care US), and/or where human or technical resources are particularly limited (Screening US, Triage US, Remote US, Primary US).

WWIINNFFOOCCUUSS ((WWoorrlldd IInntteerraacctt iivvee NNeettwwoorrkk FFooccuusseedd OOnn CCrrii tt iiccaall UUll tt rraaSSoouunndd)) The world leader scientific organization committed to develop point-of-care ultrasound

practice, research, education, technology, and networking, addressing the needs of patients, institutions, services, and communities in “critical” scenarios.

WWIINNFFOOCCUUSS VViissiioonn aanndd MMiissssiioonn SSttaatteemmeennttss Improving Primary, Emergency, and Critical Care Medicine, by incorporating "point-of-care" Ultrasound into Clinical Practice … bringing quality “Point-of-care” Ultrasound to the patient

in all out-of-hospital and in-hospital “critical” scenarios, by developing and fostering, on a global and multi-disciplinary basis, Ultrasound Education, Technological Development,

Evidence-based Research, and International Teamwork.

WINFOUS Global Education Program

ULTRASOUND LIFE SUPPORT- Basic Level 1 PROVIDER [Entry course valid for the “WINFOCUS- USLS BL1 P” International Certification]

Day 1 Day 2

08:00 REGISTRATION, PRE-COURSE TEST 08:15 REVIEW, Q/A ENRICO STORTI

I N T R O

08:30

Point-of-care UltraSound: empowering primary, emergency& critical care worldwide.

LUCA NERI

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08:30

ASSESSMENT:

Peritoneal, pleural & pericardial effusion: FAST windows.

ADI OSMAN

PROCEDURES:

Paracentesis, DPL, laparotomy.

ADI OSMAN 08:50

Ultrasound techniques: image generation, acquisition, interpretation & administration.

ADI OSMAN

09:00

ASSESSMENT: Retro-peritoneal e parenchymal haematomas, pelvic fractures.

Soft tissue hematomas, dyaphisal fractures. CARMELA GRACI

ULTRASOUND PRIMARY MANAGEMENT

A

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A Y

09:20

ASSESSMENT:

Obstruction/atelectasis, tracheal displacement and lesions, SC emphysema. Prandial status.

PROCEDURES: ET intubation, crico-thyroidotomy, tracheo-tomy/-stomy.

MANAGEMENT: Airway Protocols & Interactive Cases [US-AIR]

ENRICO STORTI

09:20

ASSESSMENT:

O&G emergencies: ectopic pregnancy, placenta praevia, uterine rupture, retroplacentarhaematoma,.

Fetus vitality (movements, heart beat), position, presentation. LUCA NERI

09:40

PROCEDURES: Peripheral & central venous catheterization.

VITO CIANCI

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09:40

ASSESSMENT:

Pleural effusion, alveolar consolidation, interstitial syndrome,

pneumothorax.

Diaphragm impairment.

Costal & sternum fractures.

VITO CIANCII

PROCEDURES:

Needle aspiration, thoraco-centesis, chest tube insertion, thoracotomy

ADI OSMAN

MANAGEMENT: Respiratory Protocols & Interactive Cases [BLUE, FALLS]

LUCA NERI

10:00

MANAGEMENT:

Cardio-circulatory Protocols & Interactive Cases [FAST, EFAST, FAST-ABCDE]

LUCA NERI

DI SA BI

LI TY

10:20

ASSESSMENT: Optic nerve& pupil abnormalities, midline shift, cervical fracture,

diaphragm impairment. Notes on focused TCD.

MANAGEMENT:

Neurological Protocols & Interactive Cases [US-NEU]

CARMELA GRACI

10:40 COFFEE BREAK 10:40 COFFEE BREAK

HA

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11:00

ULTRASOUND PRACTICE:

Knobology, US Anatomy, Airway, Breathing.

ALL FACULTY HA

ND

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11:00

ULTRASOUND PRACTICE:

Circulation [FAST, OBGYN, Access], Disability.

ALL FACULTY

13:00 LUNCH 13:00 LUNCH

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14:00

ASSESSMENT:

Introduction to echocardiography: Goals, indications and limitations, cardiac and caval vein

windows. VITO CIANCI

ULTRASOUND SECONDARY MANAGEMENT & MONITORING

HE

AD

14:00

Ocular lesions: retinal detachment, vitreous hemorrhage, lens dislocation, bulbar injuries. Skull fractures. Sinusitis, hemo-sinus.

ENRICO STORTI

14:20

ASSESSMENT: Focused hemodynamic assessment: heart morphology/performance/filling state, pericardial

effusion/tamponade, IVC variations, valvular lesions. CARMELA GRACI

PROCEDURES:

Pericardio-centesis. US-guided TC & IV pacing, ROSC evaluation. ADI OSMAN

TH

OR

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14:20

Pleural and lung septic and neoplastic lesions.

Lung monitoring and alveolar recruitment.

Focused hemodynamic monitoring.

ENRICO STORTI

AB

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14:40

Gallbladder sepsis, stones, hydrops.

Renal sepsis, stones, hydro-nephrosis.

Intestinal sepsis, occlusion, ischemia.

Nasogastric tubing and urinary catheterization.

VITO CIANCI

15:00

ASSESSMENT:

Deep venous system: deep venous thrombosis, pulmonary

embolism.

VITO CIANCI

LIM

BS

15:00

Focused MMSK and vascular lesions, soft tissue sepsis.

Foreign body detection and extraction.

CARMELA GRACI

15:20

ASSESSMENT:

Abdominal & thoracic aorta: aneurysm, dissection and rupture. CARMELA GRACI

US

LS

15:20

ULTRASOUND LIFE SUPPORT PROTOCOLS:

US Trauma Life Support [US TLS]

US Advanced Cardiac Life Support [US ACLS] VITO CIANCI

LUCA NERI

17:40

MANAGEMENT:

Cardio-circulatory Protocols & Interactive Cases [FEEL, FATE, US ACLS]

ADI OSMAN

H4

ALL

17:40

WINFOCUS GLOBAL ULTRASOUND: An innovative paradigm for sustainable human development.

LUCA NERI

HA

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15:40

ULTRASOUND PRACTICE:

Circulation [Heart, IVC, Veins, Aorta].

ALL FACULTY HA

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16:40

ULTRASOUND PRACTICE:

Head-To-Toes, US-ACLS & US-TLS.

ALL FACULTY

18:00 SESSION CLOSURE 18:00 POST-COURSE TEST, SESSION CLOSURE

UUSSCCMMEE GGLLOOBBAALL PPRROOGGRRAAMM DDIIRREECCTTOORRSS::

Chair: Luca Neri (Milan, Italy) Co-chairs : Richard Hoppmann (Columbia, SC, USA), Enrico Storti (Milan, Italy) Advisors: Michael Blaivas (Atlanta, GA, USA): Winfocus President, RESCUE & ILCEUS Chair

Daniel Lichtenstein (Paris, France): Winfocus Scientific Comm. Chair

UUSSCCMMCC LLEEAARRNNIINNGG CCOONNTTEENNTTSS aanndd FFOORRMMAATT ::

The applications targeted in the USCMC (www.winfocus.org/uscme/uscmc ~ Ultrasound Critical Management Certification) program rely on the most recent literature and recommendations, and refer mostly to the “Critical Care Medicine Journal” Supplement fully dedicated to the ultrasound applications in the acute and critical patients (Crit Care Med 2007;35[Suppl]), written by a few dozens of the actual major world experts in the field,

coordinated by Blaivas, Kirkpatrick and Sustic, and mostly involved in the Board of WINFOCUS. Proposed educational formats and pathways refer to a working document, published in its earliest version in the same

supplement (Neri L, Storti E, Lichtenstein D, Toward an ultrasound curriculum in critical care medicine. Crit Care Med 2007;35[Suppl]:S290–S304), starting point of an International evidence- and consensus-based process,

join to the USCME and ILCEUS projects (www.winfocus.org/rescue/ilceus).

UUSSCCMMCC EEDDUUCCAATTIIOONNAALL CCEERRTTIIFFIICCAATTIIOONN RROOAADDMMAAPP ::

Certification steps are implemented along the three EFSUMB levels of proficiency (www.efsumb.org):

• Level 1 (BL1 & AL1, Basic and Advanced) - Common, general, focused competency

• Level 2 (BL2 & AL2, Basic and Advanced) - Comprehensive, specialized competency

• Level 3 (beyond standards, still to be defined) - Outstanding clinical, educational, research expertise

Each level includes Provider and Trainer competence-based modules (see below as ex. the USLS roadmap):

“ULTRASOUND LIFE SUPPORT” competence-based certification pathways:

• USLS BL1 Provider >> Trainer (“ABCDE” conformed, non-specialty-specific, general)

• USLS AL1 Provider >> Trainer (“Head-to-Toes” conformed, setting/specialty-specific, general)

• USLS BL2 Provider >> Trainer (Problem-based, setting/specialty-specific, specialized)

• USLS AL2 Provider >> Trainer (Organ/District-based, setting/specialty-specific, sub-specialized)

Ex. ECHO-AL2 Provider >> Trainer (Advanced “Echo-Doppler in ICU” competences)

According specific performance needs, several Level 1 and 2 (L1, L2) UltraSound Life Support and Procedural modules are available, both for Providers and Trainers (P, T):

• US-TLS (US Trauma Life Support, ATLS-conformed)

• EFAST (Extended Focused Assessment with Sonography for Trauma)

• US-ACLS (US Cardio-Pulmonary Life Support, ACLS/ALS-conformed) • US-BLSD (US Cardio-Pulmonary Life Support, BLS/LSD-conformed)

• US-NPLS (US Neonatal & Pediatric Life Support, PALS-conformed) • US-PHLS (US PreHospital Care & Disaster Medicine Triage)

• US-Triage (US Triage in Disaster Medicine)

• CC ECHO (Critical Care Echocardiography or ECHO ICU) • US-MON (US ABCDE Monitoring)

• US-SEPS (US Sepsis Management)

• US-GPE (US General Practice in Emergency) • US-PHC (US Primary Health Care in scarce-resource-setting)

• US-NURSE (US Nursing care in Emergency)

• US-AIR (US Airway Management) • US-CVA (US Central Vascular Access Management)

• US-PVA (US Peripheral Vascular Access Management)

• US-BLOCK (US-guided Nerve Blockage)

Note: USLS BL1 Certification includes US-TLS, US-PHLS, EFAST, US-BLS, US-ACLS credentialing.

Each certification module is developed along three learning phases and a final examination:

• Part Ia: preliminary e-learning (lectures, interactive sessions, references)

• Part Ib: 1-2 days introductory course (theory, hands on, and simulation components)

• Part II: 1-6 months proctored practice (specific minimal requirements)

• Part III: 1 day credentialing examination (presentation, questionnaire, simulation-based practice)

Each credential profile undergoes maintenance and quality assurance processes:

• Refresh: 1-2 day course (every 2 years; specific annual minimal requirements)

UUSSCCMMEE AAUUDDIIEENNCCEE TTAARRGGEETTSS ::

- Health care professionals: Physicians, Nurses, Paramedics, Midwives, and Technicians … working in

- “Critical” scenarios: EM, CCM/ICU, Acute/Trauma Surgery, HEMS/EMS, PHC, Pediatric, Sport, Tactical, Remote, Rural, Wilderness, Scarce-resource settings.

Further details at www.winfocus.org/uscme

UUSSCCMMCC CCEERRTTIIFFIICCAATTIIOONN ~~ UUSSLLSS BBLL11 && AALL11 ffoorr PPRROOVVIIDDEERRSS