Ultrasound in the ED

A room at the Adelaide Convention Centre might seem an unlikely setting for sharing insights into using ultrasound in emergency departments. However, the Progress PoCUS (Point of Care Ultrasound) workshop at ACEM’s recent Annual Scientific Meeting (ASM) last November proved to be a popular inclusion on the event’s program. 

Progress PoCUS supports trainees and FACEMs who are pursuing ACEM’s training and recommended ultrasound credentialing pathway. Ultrasound experts were present to proctor scans, as well as carry out formative and summative assessments for Extended Focused Assessment with Sonography in Trauma (eFAST), abdominal aortic aneurysm (AAA), lung, Focused Echo in Life Support (FELS) and procedural guidance.

Proctored scans were then entered into each participants’ logbook (for hospital credentialing or for Certificate in Clinician Performed Ultrasound (CCPU) purposes). The day ended with a SLICE protocol review (aka the ‘quick and easy’ Rapid Ultrasound for Shock and Hypotension (RUSH) protocol) and provided eight hours of professional development education that also offered ASM attendees an opportunity for networking and socialising. 

More training supports better patient care

With additional Progress POCUS workshops scheduled throughout 2025, FACEM Dr Elissa Kennedy-Smith is keen to encourage more people to sign up.

“‘I saw point of care ultrasound used in the emergency department and just realised it was going to be a game-changer.’”

— FACEM Dr Elissa Kennedy-Smith

She is an emergency physician who has worked in EDs across Victoria and NSW and who has sub-specialty interests in both PoCUS (gaining her Diploma of Diagnostic Ultrasound – Emergency Medicine in 2017) and early pregnancy. Dr Kennedy-Smith is also the former Chair of the ACEM Emergency Department Ultrasound Committee. 

Her passion for utilising PoCUS in the ED began more than two decades ago when she was a registrar. 

‘I saw Point of Care Ultrasound used in the emergency department and just realised it was going to be a game-changer,’ she said. ‘Instead of wondering if a patient had blood in their belly, I could look and see if they actually did. Instead of wondering if someone had gallstones, I could just look and see for myself. Instead of using a stethoscope to listen for a cardiac murmur, I could look and work out exactly what that murmur is, with my own eyes. 

‘My immediate reaction was, “Oh wow, this is going to make such a positive difference to my capabilities in looking after patients”.’ 

But Dr Kennedy-Smith said it is not an easy skill to learn. Not only do emergency physicians require hands-on image acquisition training, but they also need the ability to interpret the results and understand its limitations. 

‘It’s a lot more difficult than learning to use a stethoscope, for example,’ Dr Kennedy-Smith said. 

Dr Kennedy-Smith said that ACEM has made it clear that ideally, FACEMs should emerge from their training proficient in the five core modalities of PoCUS, as they are now included in the FACEM curriculum.

However, she said it is ‘quite tricky’ for ACEM trainees to successfully complete their training of those modalities – especially in less-resourced EDs and in regional, rural and remote locations – because of the lack of FACEMs who are specifically trained in those five areas. 

‘To be competent as a trainee means someone has to have trained you, and the current situation is that not every single site has an adequately trained FACEM to pass that learning on,’ Dr Kennedy-Smith said. 

It’s a reality that the current Chair of ACEM’s ED Ultrasound Committee, Dr Nadi Pandithage, would also love to change. 

“‘We’re definitely making good progress with Progress PoCUS.’”

— FACEM Dr Nadi Pandithage

Dr Pandithage is a senior emergency physician who has worked as a specialist in Darwin for 20 years. She joined ACEM’s Examiner Board in 2009 and became the first examiner based in the Northern Territory.

Dr Pandithage became qualified to teach PoCUS late in her career after noting the deficit in PoCUS teaching and training in the NT. After finishing all the emergency-related CCPUs, she completed a Diploma of Diagnostic Ultrasound in Emergency Medicine and is now the Clinical Lead in Ultrasound (CLUS) at her hospitals. She is also a passionate supporter of PoCUS teaching throughout Australasia for everyone from medical students right through to specialists. 

Dr Pandithage said reaching the sweet spot of having enough trainers in PoCUS is now ‘well on the way’. 

‘I do think we are still maybe two years away from that time when the majority of FACEMs are competent in those five modalities and can help ACEM’s new trainees gain their own skills and competencies,’ Dr Pandithage said. 

‘But we’re definitely making good progress with Progress PoCUS.’ 

Sharing education and understanding

Each PoCUS workshop has a ratio of one trainer instructor per every four participants. 

‘It is quite a full-on day for everyone involved, with lots of talking and lots of knowledge shared,’ Dr Kennedy-Smith said. 

Prior to attending the training, workshop attendees are invited to answer questions outlining who they are and whether they want to focus on a specific modality. 

‘Not everyone comes to a Progress PoCUS workshop to do summative assessments,’ she said. ‘At a recent workshop in Victoria, we had a couple of junior trainees come along and they just wanted to practise all day.’ 

“‘The PoCUS workshops are about ensuring as many people as possible have the proper training to know how to use the technology effectively and be able to use it in the right way and interpret the results accurately.’”

— FACEM Dr Elissa Kennedy-Smith

‘It really helps us get ready for the workshop if we have a good understanding of what brings people there to do the training.’ 

For those who attend to complete a summative assessment, there are pre-workshop online ultrasound modules to complete through the elearning page on the ACEM website.

‘It’s between three to five hours of modules,’ Dr Kennedy-Smith said. 

Attendees are sent information about the assessment requirements around three weeks before the in-person workshop. 

With PoCUS technology already in EDs across the country, Dr Kennedy-Smith said that it is vital to encourage more trainees and FACEMs to complete the training to help deliver the best outcomes for patients.

Dr Kennedy-Smith shared that more than 300 summative assessments have been successfully completed since launching Progress PoCUS in 2023.

‘The PoCUS workshops are about ensuring as many people as possible have the proper training to know how to use the technology effectively and be able to use it in the right way and interpret the results accurately,’ she said. 

‘We’re not introducing a new concept. PoCUS is in EDs across Australia and Aotearoa New Zealand. Now we want emergency physicians to make the most of that tool and to help ACEM trainees learn how to make the most of it too.’ 

PoCUS workshops in 2025: