TECHNICAL REPORT

Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians Jennifer R. Marin, MD, MSc, Resa E. Lewiss, MD, AMERICAN ACADEMY OF PEDIATRICS, Committee on Pediatric Emergency Medicine; SOCIETY FOR ACADEMIC EMERGENCY MEDICINE, Academy of Emergency Ultrasound; AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, Pediatric Emergency Medicine Committee; WORLD INTERACTIVE NETWORK FOCUSED ON CRITICAL ULTRASOUND

Emergency physicians have used point-of-care ultrasonography since the abstract 1990s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed Point-of-care ultrasonography (US) is a bedside technology that enables conflict of interest statements with the American Academy of fi Pediatrics. Any conflicts have been resolved through a process clinicians to integrate clinical examination ndings with real-time approved by the Board of Directors. The American Academy of sonographic imaging. General emergency physicians and other specialists Pediatrics has neither solicited nor accepted any commercial have used point-of-care US for many years, and more recently, pediatric involvement in the development of the content of this publication. emergency medicine (PEM) physicians have adopted point-of-care Technical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and US as a diagnostic and procedural adjunct. This technical report and external reviewers. However, technical reports from the American accompanying policy statement1 provide a framework for point-of-care Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. US training and point-of-care US integration into pediatric care by PEM physicians. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

HISTORY OF EMERGENCY PHYSICIAN POINT-OF-CARE US All technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, In 1990, the American College of Emergency Physicians (ACEP) published revised, or retired at or before that time. a position statement supporting the performance of US by appropriately www.pediatrics.org/cgi/doi/10.1542/peds.2015-0343 trained emergency physicians.2 The next year, the Society for Academic DOI: 10.1542/peds.2015-0343 Emergency Medicine endorsed that statement and called for a training curriculum, which Mateer and colleagues published in 1994.3,4 By 1996, PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). the published emergency medicine core content included point-of-care Copyright © 2015 by the American Academy of Pediatrics

Downloaded from www.aappublications.org/news by guest on September 26, 2021 PEDIATRICS Volume 135, number 4, April 2015 FROM THE AMERICAN ACADEMY OF PEDIATRICS US for residency graduates.5 With the guidelines specific to pediatric sonography in trauma examination passage of the American Medical emergency providers. The indications may demonstrate free peritoneal Association Resolution 802 and pol- set forth in existing policy statements fluid at baseline in a patient with icy H-230.960 in 1999, “recommend- are written for emergency a ventriculoperitoneal shunt). ing hospital [privileging] committees physicians who predominantly care fi recognize specialty-speci c guide- for adult patients. DEVELOPMENT OF A POINT-OF-CARE US ”6 lines for US credentialing decisions, PROGRAM emergency physicians were given DIAGNOSTIC AND PROCEDURAL The development of a point-of-care full responsibility for developing INDICATIONS the guidelines of their field. By 2001, US program begins with a clinical the Accreditation Council for Gradu- To date, numerous diagnostic and need for these services. It is not ate Medical Education mandated that procedural applications for point-of- necessary that all relevant all emergency medicine residents care US have been described. The applications be introduced at the attain competency in the use of point- literature supports the ability of same time. In fact, it is most effective of-care US,7 and the ACEP published general emergency physicians to to identify the applications that will the first emergency US guidelines.8 use point-of-care US to improve the be the most important in emergent In 2008, the ACEP published an care of adult patients by accurately scenarios or most commonly used. update to the original guidelines, diagnosing time-sensitive and The program may then be extended 15–38 thereby establishing the most com- common ED conditions, as PEM physicians become more fi prehensive specialty-specific training decreasing patient lengths of pro cient. Point-of-care US has 15,39–41 and practice to date.9 Subsequently, stay, and reducing become more prevalent in 15,42–45 60 the Society for Academic Emergency complications. Furthermore, medicine, and consequently more Medicine, the Council of Emergency emergency physicians are able to physicians are using this bedside Medicine Residency Directors, and achieve competency in performing technology. Preparing the workforce the American Institute of Ultrasound point-of-care US for various of the future for point-of-care in Medicine officially recognized that indications after completing adequate US means embedding training 20,26,46–48 document.10,11 Currently, guidelines training. strategies in the infrastructure of from the Council of Emergency Point-of-care US in pediatric patients residency and fellowship training. Medicine Residency Directors by PEM providers has recently been Point-of-Care US Leadership consensus documents from 2009 and adopted into practice, and the 2012 are a mainstay for residency literature is still evolving. A point-of-care US director or core education.10,12 In addition, compe- Nonetheless, there are numerous group of leaders is established to tency assessment tools for the evalu- studies demonstrating the accuracy facilitate and manage the educational ation of emergency medicine of point-of-care US by PEM and administrative tasks of residents are being considered.12 physicians49–58 and the ability of coordinating a point-of-care PEM physicians to become proficient US program within a division or department. Overall, responsibilities POINT-OF-CARE US IN PEDIATRIC in point-of-care US after adequate EMERGENCY MEDICINE training.55,56,59 Although the point-of- for developing a program include education for the clinician operators More recently, PEM physicians have care US examinations performed fi and administrative processes and been using point-of-care US for should be speci c to the needs of the department, the most common procedures for credentialing and patient care. According to a survey quality assurance (QA). from 2011, 95% of emergency indications for which point-of-care US departments (EDs) with a PEM is being used in PEM are for focused The point-of-care US director fi fellowship program use point-of-care assessment with sonography in (or several directors) has signi cant US in some manner, and 88% of trauma, soft tissue evaluation, and US experience encompassing the 13 programs provide training in point- vascular access. breadth of pediatric point-of-care of-care US for their fellows.13 This is Physicians should be aware that US applications. As more PEM a dramatic increase, because only examinations in children and point-of-care US fellowships 57% of programs reported the use of adolescents with disabilities and become available, it is likely that point-of-care US in 2006, and only chronic medical problems may be US directors will be fellowship- 65% at that time incorporated more challenging to perform and trained. training for their fellows.14 Despite integrate. As always, interpretations The director works with the the growing use of point-of-care US should be made carefully in the departmental leaders to define by pediatric emergency physicians, context of the clinical scenario a vision and goals for the program. there have been no published (eg, the focused assessment with These include equipment accrual,

Downloaded from www.aappublications.org/news by guest on September 26, 2021 e1114 FROM THE AMERICAN ACADEMY OF PEDIATRICS training guideline development, or endocavitary transducer, which can patterns of the division or QA program development, payment be used for applications including department to meet the needs of all strategies, workflow solution pelvic imaging and peritonsillar learners. Alternatively, the director implementation for image storage, abscesses, may be useful depending may choose to highlight a specific and creation of credentialing and on the patient population and group, such as attending physicians, privileging documents. physician practice patterns. Obtaining and develop a focused plan to train service agreements and warranties them and use their skills in providing Equipment with equipment purchasing are training to the other members of the important because the equipment division or department. Another Selecting the appropriate equipment undergoes more physical option is to develop US fellows as depends on a number of factors, deterioration than similar equipment educators and to have them train including image quality, number of in an isolated suite used by fewer attending physicians in turn. users, breadth of use, ease of use, technicians. Regardless of the approach, it is storage space, connectivity options, important to understand and memory storage needs, budget, and Education and Training appreciate that learning point-of-care local contracts with manufacturers When developing a US program, it is US at any level is time intensive. at each institution. important to consider the spectrum Overall, it is important to provide According to the American Institute of learners, their willingness to accept a spectrum of didactic and hands-on of Ultrasound in Medicine’s “Routine new innovations, and their learning opportunities that will assist the Quality Assurance for Diagnostic styles. Each learner needs special learner in mastering this technical Ultrasound Equipment,” there are educational attention, and several and interpretive skill. 2 types of QA needs: cleanliness and options for US education may be Interdepartmental Considerations safety, and image display and used. As an introduction to US, performance.61 The regular cleaning physicians may use asynchronous Working with other medical specialty and daily maintenance of the online learning material through Web departments may be useful when machinery may be performed by sites, podcasts, or blogs, for example. beginning a point-of-care US program. users, biomedical engineering staff, Synchronized time through an 8- to Specifically, the point-of-care US or environmental service staff and 16-hour course with education and directors may find that their US should follow guidelines of the hands-on experience is a standard efforts parallel an undeveloped desire Joint Commission. The technical foundation for introductory US of physicians in other disciplines who performance of the machine may be training and has been recommended seek to incorporate US into their maintained by the manufacturer if the in the ACEP 2008 “Emergency practice. Because specialties such as machine is under a service contract, Ultrasound Guidelines” and other radiology and cardiology have a long and those in the ED may be publications.9,62,63 Additionally, history with US use, early responsible for QA. simulation centers may provide collaboration with these departments Many departments with established a learning environment to teach and may enhance the development of programs have, at a minimum, demonstrate the practice of point-of- a PEM point-of-care US program. a low-frequency and a high-frequency care ultrasound. Finally, bedside In addition, the general emergency transducer. The high-frequency linear teaching of US on patients is an medicine community has developed transducer can be used in pediatrics important part of any educational a robust national and international presence to advocate for point-of-care for the soft tissues, abdomen, lung, paradigm, including instruction in US. They have established guidelines and spine and for procedural acquiring high-quality images, and policy statements regarding the guidance. For the evaluation of interpreting these images, and use of point-of-care US in the ED.9,10 deeper structures and evaluation of incorporating these data into bedside Collaboration with neighboring or the chest and abdomen, a lower- medical decision-making. Evidence affiliated general EDs may also prove frequency transducer will provide suggests this is the best method for beneficial. improved visualization. The phased- learners to understand this 64 array transducer, with its smaller modality. footprint, is attractive for use in Most novice learners report time POINT-OF-CARE US TRAINING AND children, given the smaller size of constraints as the major hurdle CREDENTIALING pediatric patients. A curvilinear toward learning US and obtaining Point-of-care US is a multifaceted transducer may be suitable for some proficiency.13 The point-of-care skill including image acquisition, applications despite the larger US director is challenged to help interpretation, and clinical footprint. Other transducers, such integrate various types of knowledge. To be considered a “hockey stick” linear transducer US education into the practice proficient in point-of-care US, PEM

Downloaded from www.aappublications.org/news by guest on September 26, 2021 PEDIATRICS Volume 135, number 4, April 2015 e1115 physicians need the skills to acquire point-of-care US, indications and feasible given the resources of technically adequate images and the limitations, and relevant fundamental a particular program, the point-of- ability to interpret these studies to physics. Practical instruction focuses care US directors may arrange for inform clinical decision-making. on machine basics (commonly trainees to enroll in an outside, Additionally, physicians should be referred to as “knobology”) and comprehensive continuing medical aware of the relevant point-of-care image acquisition. education (CME) course that includes US applications and how they apply basic and advanced applications. to the patient population. Rotation Components Alternatively, trainees may arrange for a rotation at another institution Many practicing PEM physicians A dedicated point-of-care US rotation received little or no point-of-care is considered necessary by many with an established rotation to US education during their training. US instructors for trainees who will receive adequate training. A pediatric fi This section includes suggestions for use point-of-care US in their field. subspecialty-speci c point-of-care a PEM trainee pathway (“Training- In some institutions, this rotation may US course or rotation at an institution Based Pathway”) and a PEM be coordinated with radiology, with a pediatric focus is preferred. practicing physician training pathway cardiology, or subspecialty-specific (“Practice-Based Pathway”). Both point-of-care US–trained physician Longitudinal Experience pathways require a combination of members. During this rotation, Beyond the point-of-care US rotation, teaching and hands-on training and trainees have adequate allocated longitudinal point-of-care US include standards for determining time free from other clinical education is important to maintain proficiency. responsibilities. The rotation is skills. This includes ongoing didactics, structured in a manner that hands-on instruction, image review, Training-Based Pathway incorporates the following features: and feedback on individual scans In general, point-of-care US education • Didactic sessions and hands-on throughout the training. Whenever programs provide trainees with instruction related to relevant possible and with patient permission, a comprehensive understanding of applications. Hands-on training trainees may scan during their point-of-care US principles and a skill should include live or simulation clinical shifts. These practice or “ ” set that allows them to incorporate models. educational scans are not used for medical decision-making. point-of-care US into their daily • Scheduled scanning sessions practice. Trainees gain proficiency in without simultaneous patient care It is important for physicians to the applications most relevant to responsibilities, with a majority obtain verbal consent from patients their practice environment, as proctored by the point-of-care and families before performing an determined by the training program. US director or qualified clinicians educational scan. Specifically, patients They also develop and understand (ie, those who have been trained and families are informed that the the advantages and limitations of and credentialed to perform US for examination would not be used to point-of-care US in their patient that indication). inform clinical decision-making, and population and practice setting. They • Image review of exemplary or de- there would not be a charge incurred identify strategies for staying partmental scans. Review of imag- for the examination. Timely feedback informed of the newest and best ing from other subspecialties may be provided on the quality evidence-based practices and (eg, radiology, cardiology) should and accuracy of the studies, with recommendations. be incorporated when appropriate. attention to improvement and maintenance of skills over time. A point-of-care US education • Timely review of individual In many institutions, longitudinal program, adapted from published scans with feedback on image trainee point-of-care US educational consensus guidelines for PEM fellow quality and interpretation 65 opportunities can be combined with US training and the ACEP policy throughout the rotation. statement on point-of-care US,9 is physician development efforts. • Required reading from selected summarized here. Programs without the resources to textbooks and journals. provide a point-of-care US rotation • Introductory Instruction Access to educational resources and longitudinal point-of-care US Trainees receive an introduction to including point-of-care US text- experience for their trainees may point-of-care US early in the course books, online resources, image use outside courses or institutions. of their training. The introduction banks, question banks, and elec- In addition, PEM fellows may incorporates didactics and hands-on tronic educational materials. supplement their training and instruction and covers important If providing a structured quality develop administrative and topics such as a brief history of point-of-care US rotation is not leadership skills in point-of-care

Downloaded from www.aappublications.org/news by guest on September 26, 2021 e1116 FROM THE AMERICAN ACADEMY OF PEDIATRICS US through additional training in performing an educational scan. services within the scope of a 1-year PEM-specific or general Specifically, patients and families are privileges granted.”9 Specifically, the emergency medicine US fellowship informed that the examination would credentialing of physicians to use program. not be used to inform clinical point-of-care US provides a framework decision-making, and there would not to ensure the appropriate training and Practice-Based Pathway be a charge incurred for the implementation of US into clinical examination. Department leadership practice. Overall, it is important that For practicing physicians who did not establishes well-defined goals for the the credentialing system be receive point-of-care US training numbers of required educational a “transparent, high quality, verifiable, during their residency or fellowship, scans in the most relevant and efficient system.”9 Credentialing point-of-care US education may be applications. Repetition will allow is typically conferred by the hospital creatively integrated into the physicians to refine their technique and is achieved through education, physician development curriculum. and improve their image acquisition training, and practice performance, Physicians can pursue training off site abilities. Ideally, hands-on scanning with subsequent evaluation of if their clinical setting does not with a point-of-care US faculty individual physician data. For provide adequate point-of-care US member should complement hospitals without an established teaching faculty or supervisors. The independent scanning. Participation credentialing process whereby practice-based pathway can focus on in image review is an important hospital privileges are granted for applications that will be of highest aspect of point-of-care US training point-of-care US, the US directors may yield for the practicing physicians and allows physicians to receive consider creating a document that based on their specialty, patient feedback on the quality and accuracy delineates the expectations for those population, and practice of their scans. By participating in seeking privileges. Credentialing environment. online educational activities and should be distinguished from Introductory Instruction attending conferences, physicians can certification, which is made possible learn about new point-of-care by documentation from an outside For physicians without US experience, US applications and stay abreast of body attesting that a person has the point-of-care US training may begin developments in the field. capability to perform and interpret with an introductory course US.66 Currently, there is no nationally consisting of both didactics and Longitudinal Experience accepted certification for physician hands-on instruction. Introduction to Establishing requirements for performance and interpretation of point-of-care US concepts and basic competency (as detailed later) will point-of-care US. Some physicians may clinical applications can be provided depend on the clinical setting and the opt to receive the Registered with online, video, or in-person complexity of the individual Diagnostic Medical Sonographer presentations. Didactics alone are application. Maintenance of point-of- certification, but this certification is insufficient. Hands-on training with care US competency requires geared toward US technicians and is live or simulation models is essential continued use of the skill. Once it has not specific to point-of-care US. for successful introductory training. been determined that a physician is Accreditation refers to the overall Experiential Training competent in a given application, evaluation of a practice, such as an continued review of a percentage of After completing an introductory US department at an institution, studies by a supervising point-of-care 66 course, physicians are encouraged to typically by a national organization. US physician is important to ensure practice the point-of-care US skills It is important that the department that the quality of scan acquisition they have learned during their clinical leaders clearly delineate how point- and accuracy of scan interpretation shifts. These practice or “educational” of-care US will be used in each does not decline after competency scans are either reviewed in real time department, and providers should has been achieved. Frequent review or saved for review by the point-of- be skilled in the point-of-care of the recent point-of-care US care US director or other qualified US indications that apply to their literature related to the applications clinicians. Feedback is best provided practice environment. The ACEP used by each subspecialty is also a part in a timely fashion on the quality and guidelines for emergency physicians of maintenance of proficiency. accuracy of the studies, with attention suggest physicians should to improvement and maintenance of successfully perform 25 to 50 skills over time. As in the training- Credentialing examinations in each application, based pathway described in the Credentialing “defines a physician’s with a required number of “true previous section, it is important for scope of practice and the clinical positives” with pathologic findings.9 physicians to obtain verbal consent services he or she may provide, and Ideally, these scans are performed in from patients and families before ensures that the physician provides the ED during clinical encounters.

Downloaded from www.aappublications.org/news by guest on September 26, 2021 PEDIATRICS Volume 135, number 4, April 2015 e1117 However, acceptable alternatives may (every 2 years) to maintain surgical outcomes when available. include scanning with other imaging competency may vary, but in general Discordant findings are monitored specialists and approved CME they should be relevant and and periodically reviewed with activities. proportional to the number of the sonologist and through the With regard to US-guided procedures, credentialed applications. The ACEP departmental morbidity and mortality the number of scans needed to define recommends 5 hours of CME for process to identify opportunities to competency varies depending on general practitioners and 10 hours improve patient care. The QA records the procedure and the clinician’s for US directors to maintain are regularly maintained and available 9 experience and comfort with the credentialing. However, particularly for review. procedure without US guidance. For when point-of-care US practitioners It is important to put a process most simple procedures with which do not have the opportunity to in place to address imaging or the clinician is already familiar, use certain examination skills on interpretive errors of clinical previous statements on point-of-care a routine basis, additional CME significance in a timely fashion US recommend performing 10 scans. hours should be considered to so that potential patient harm is For other applications, the clinician maintain an appropriate knowledge avoided. This includes instances of – may require additional scans base and skill level (eg, 10 15 hours misinterpretation and the omission (25–50).9 per year). of necessary views. The treating physician, QA director, US director, Maintenance of Competency POINT-OF-CARE US QUALITY or equivalent ensures that proper follow-up is established, including Hospitals typically reappoint ASSURANCE AND QUALITY IMPROVEMENT a return to care if necessary, physicians and renew their clinical and documentation of privileges at regular intervals. To Examinations are reviewed and communication is reflectedinthe renew hospital privileges, a physician evaluated on a regular basis as part patient’scharting. must “demonstrate current clinical of the overall QA and improvement competence, skill, judgment, and program at each institution. The Documentation and Archiving ”9 technique. This includes performing purpose of the QA process is to The manner of documentation for the fi services as speci ed in their clinical evaluate for maintenance of point-of-care US (eg, hand-written, privileges on a regular basis and a minimum standard quality of templated on a computer, or other) keeping up to date on the current image acquisition and accurate depends on the medical record literature. In addition to the minimum interpretation. An integral component system of the institution. fi number of hours of CME didactics, to point-of-care US is the identi cation Communication with individual clinicians perform a certain number of a person (or people) who will be insurance companies and regulators of scans per year to maintain responsible for ongoing monitoring may assist with clarifying the exact privileges, with monitoring of their and QA. This may consist of the wording and level of detail for accuracy and remediation when US director or an equivalent person additional purposes of payment. 67 necessary. with requisite knowledge and Elements to include in the Point-of-care US is an acquired skill experience. Assistance in this capacity documentation are68,69 indications for requiring training and practice. may be obtained from physicians with the examination; name of sonologists Accordingly, ongoing maintenance of requisite US experience who work or certified physician performing proficiency through CME is outside the pediatric ED (eg, critical imaging; views and findings, including important. This may be accomplished care, general emergency medicine, incidental findings; limitations and in a number of different formats, radiology). recommendations for additional including departmental US In general, the person responsible for studies; impression and medical conferences, regional courses, image QA regularly reviews images and decision-making; and permanently review sessions, online educational provides timely feedback to recorded images as part of the medical activities, morbidity and mortality physicians performing point-of-care record. Maintaining standardized conferences that have a specific US. Images are assessed for technical documentation ensures that all point-of-care US component, in- components (eg, gain, depth, relevant information for a given service examinations, textbook and orientation, labeling, and focus) and examination is included for easier journal readings, and research. interpretative accuracy, comparing review, data inquiries, retrieval for Hands-on sessions are preferred for the point-of-care US findings with research, and inclusion of all necessary physicians who use point-of-care comprehensive or consultant imaging elements for billing compliance.70 US less frequently. The number of in all cases in which these are Images may be archived in a variety of CME hours required per CME cycle obtained, as well as medical or formats. The types of imaging may

Downloaded from www.aappublications.org/news by guest on September 26, 2021 e1118 FROM THE AMERICAN ACADEMY OF PEDIATRICS include printed thermal images, digital Alyssa M. Abo, MD Alan E. Jones, MD still images, or video clips. Archiving Stephanie J. Doniger, MD, RDMS Amy H. Kaji, MD, PhD Jason W. Fischer, MD, MSc Ian B. K. Martin, MD solutions may include CDs, digital David O. Kessler, MD, MSc, RDMS Christopher Moore, MD, RDMS, RCMS video discs, hard drives, local servers, Jason A. Levy, MD, RDMS Nova Panebianco, MD, MPH third-party proprietary digital archival Vicki E. Noble, MD, RDMS servers, or picture archiving and Adam B. Sivitz, MD AMERICAN COLLEGE OF EMERGENCY communication system programs. James W. Tsung, MD, MPH PHYSICIANS, PEDIATRIC EMERGENCY Rebecca L. Vieira, MD, RDMS – The solution should comply with MEDICINE COMMITTEE, 2013 2014 relevant regulatory and individual CONTRIBUTING AUTHORS Lee S. Benjamin, MD, FACEP, Chairperson institutional risk management Kiyetta Alade, MD David Bahner, MD Joseph Arms, MD policies. Rachel Gallagher, MD, RDMS Jahn T. Avarello, MD, FACEP Steven Baldwin, MD AMERICAN ACADEMY OF PEDIATRICS, CONCLUSIONS Isabel A. Barata, MD, FACEP, FAAP COMMITTEE ON PEDIATRIC EMERGENCY Kathleen Brown, MD, FACEP The evidence in support of point-of- MEDICINE, 2013–2014 Richard M. Cantor, MD, FACEP care US as an adjunct to the clinical Joan E. Shook, MD, MBA, FAAP, Chairperson Ariel Cohen, MD Alice D. Ackerman, MD, MBA, FAAP Ann Marie Dietrich, MD, FACEP effectiveness of PEM physicians is Paul J. Eakin, MD growing. Over time, more pediatric Thomas H. Chun, MD, MPH, FAAP Gregory P. Conners, MD, MPH, MBA, FAAP Marianne Gausche-Hill, MD, FACEP, FAAP EDs will develop point-of-care US Nanette C. Dudley, MD, FAAP Michael Gerardi, MD, FACEP, FAAP programs. By establishing training, Susan M. Fuchs, MD, FAAP Charles J. Graham, MD, FACEP credentialing, and QA programs, Marc H. Gorelick, MD, MSCE, FAAP Doug K. Holtzman, MD, FACEP Natalie E. Lane, MD, FAAP Jeffrey Hom, MD, FACEP a director or core group of leaders Paul Ishimine, MD, FACEP can ensure that this technology is Brian R. Moore, MD, FAAP Joseph L. Wright, MD, MPH, FAAP Hasmig Jinivizian, MD implemented in a safe and effective Madeline Joseph, MD, FACEP manner. Ultimately, this will improve LIAISONS Sanjay Mehta, MD, MEd, FACEP the care of pediatric patients. As stated Aderonke Ojo, MD, MBBS Lee Benjamin, MD – American College of Emergency “ ” Pediatrics, Audrey Z. Paul, MD, PhD in a Perspectives article in Physicians Denis R. Pauze, MD, FACEP “ as much as it is our responsibility to Kim Bullock, MD – American Academy of Family Physicians Nadia M. Pearson, DO understand the limitations and Elizabeth Edgerton, MD, MPH, FAAP – Maternal and Brett Rosen, MD challenges associated with integrating Child Health Bureau W. Scott Russell, MD, FACEP Toni K. Gross, MD, MPH, FAAP – National Association point-of-care US into pediatrics, it is Mohsen Saidinejad, MD of EMS Physicians Gerald R. Schwartz, MD, FACEP our responsibility to our patients to Tamar Magarik Haro – AAP Department of Federal Affairs Harold A. Sloas, DO stay abreast of the most current Angela Mickalide, PhD, MCHES – EMSC National Orel Swenson, MD advances in medicine and provide the Resource Center Jonathan H. Valente, MD, FACEP safest, most efficient, state-of-the-art Elizabeth L. Robbins, MD, FAAP – AAP Section on Muhammad Waseem, MD, MS Hospital Medicine care. Point-of-care US can help us meet Paula J. Whiteman, MD, FACEP Lou E. Romig, MD, FAAP – National Association of Dale Woolridge, MD, PhD, FACEP ”71 this goal. Emergency Medical Technicians Sally K. Snow, RN, BSN, CPEN, FAEN – Emergency FORMER COMMITTEE MEMBERS LEAD AUTHORS Nurses Association Carrie DeMoor, MD David W. Tuggle, MD, FAAP – American College of Surgeons Jennifer R. Marin, MD, MSc James M. Dy, MD Cynthia Wright, MSN, RNC – National Association of Resa E. Lewiss, MD Sean Fox, MD State EMS Officials Robert J. Hoffman, MD, FACEP FINANCIAL DISCLOSURE/CONFLICT OF Mark Hostetler, MD, FACEP INTEREST STAFF David Markenson, MD, MBA, FACEP Dr Lewiss has no financial disclosures or potential Sue Tellez Annalise Sorrentino, MD, FACEP conflicts of interest. Dr Marin receives support Michael Witt, MD, MPH, FACEP from 3rd Rock Ultrasound, LLC for serving as SOCIETY FOR ACADEMIC EMERGENCY teaching faculty and received support from the MEDICINE (REVIEWERS) STAFF Agency for Healthcare Quality and Research Dan Sullivan Steven B. Bird, MD (R13HS023498) related to a conference on Andra L. Blomkalns, MD Stephanie Wauson diagnostic imaging and from the National Kristin Carmody, MD Institutes of Health (K12HL109068). WORLD INTERACTIVE NETWORK Kathleen J. Clem, MD, FACEP FOCUSED ON CRITICAL ULTRASOUND D. Mark Courtney, MD PEDIATRIC POINT-OF-CARE ULTRASOUND Deborah B. Diercks, MD, MSc BOARD OF DIRECTORS (REVIEWERS) WORKGROUP Matthew Fields, MD Vicki Noble, MD Jennifer R. Marin, MD, MSc, Chairperson, Lead Robert S. Hockberger, MD Enrico Storti, MD Author James F. Holmes, Jr, MD, MPH Jim Tsung, MD Resa E. Lewiss, MD, Lead Author Lauren Hudak, MD Giovanni Volpicelli, MD

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Downloaded from www.aappublications.org/news by guest on September 26, 2021 Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians Jennifer R. Marin, Resa E. Lewiss, AMERICAN ACADEMY OF PEDIATRICS, Committee on Pediatric Emergency Medicine, SOCIETY FOR ACADEMIC EMERGENCY MEDICINE, Academy of Emergency Ultrasound, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, Pediatric Emergency Medicine Committee and WORLD INTERACTIVE NETWORK FOCUSED ON CRITICAL ULTRASOUND Pediatrics originally published online March 30, 2015;

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