Equipping Rural Health Care Providers to Diagnose COVID-19
A physician in Bisbee, Arizona, performs an ultrasound while a doctor in Tucson observes remotely via a livestream.
A lung ultrasound education program developed by the University of Arizona Health Sciences will make it easier to diagnose COVID-19 in rural areas, where the pandemic is having a disparate impact and access to CT scan capabilities and COVID-19 testing is often limited.
Elaine Situ-LaCasse, MD, an assistant professor in the Department of Emergency Medicine at the UArizona College of Medicine – Tucson, is leading the effort to develop the ultrasound education program for rural emergency medicine providers, who will be connected remotely to ultrasound experts for education, image review, consultation and quality assurance. Her team’s goal is to create a sustainable, reproducible and scalable tele-ultrasound education program to help rural emergency department physicians feel more comfortable performing lung ultrasounds in the diagnosis and management of suspected or confirmed COVID-19 patients.
In Southern Arizona, Dr. LaCasse is partnering with Copper Queen Community Hospital in Bisbee, along with the hospital’s clinic in Douglas, to train physicians in the technology. The 25-bed hospital recently transformed a boardroom into a space for overflow beds in preparation for the COVID-19 pandemic. So far, that space hasn’t been used for emergencies and instead is the training site for rural health care providers learning how to use bedside lung ultrasound.
Holding a bedside ultrasound device, Elaine Situ-LaCasse, MD, a UArizona College of Medicine – Tucson assistant professor, won a grant to train rural providers on lung ultrasound as a quicker, more efficient way to evaluate patients who may have COVID-19.
From their base in the College of Medicine – Tucson, Dr. Situ-LaCasse and her mentor, Srikar Adhikari, MD, professor of emergency medicine, discuss bringing bedside ultrasound devices to rural communities, expanding access to the technology.
The county seat of Cochise County, Bisbee is home to 5,225 people, located 90 miles southeast of Tucson in the Mule Mountains. Bisbee is one community that is piloting bedside lung ultrasounds to diagnose COVID-19.
Copper Queen Community Hospital in Bisbee, Ariz., provides basic primary health care to southern Cochise County. It was founded in 1884, when Bisbee was a boomtown with a thriving mining industry. Pictured here is the entrance to the hospital’s emergency department.
Soundwaves travel through gel and bounce off internal tissues to produce an ultrasound image of the body’s insides.
Working with a “standardized patient,” a specialist who portrays patients when health care providers train in new procedures, a doctor learns how to perform bedside lung ultrasound. The physician would wear gloves when treating patients.
Dr. Elaine Situ-LaCasse (pictured on the laptop) receives a livestream of the exam results and assists in diagnosing a standardized patient during a telehealth training consultation with Julia Brown, MD, emergency department medical director at the Copper Queen Community Hospital in Bisbee, Arizona.
Julia Brown, MD, explains the images from the lung ultrasound to her standardized patient.
Viewing the results of a lung ultrasound, Julia Brown, MD, leaves the emergency department of the hospital. Evidence is mounting for the effectiveness of lung ultrasound in diagnosing and assessing the severity of coronavirus infections in emergency departments, where it could be an alternative to chest X-ray and CT chest scans when combined with a clinical examination.
Cristian Laguillo, MD, Copper Queen Community Hospital inpatient medicine director, discusses the bedside ultrasound machine with Julia Brown, MD, and Glenda Trevino, RN, nursing education director. As a family medicine doctor, Dr. Laguillo was excited about the potential of this technology in non-emergency settings.
The Copper Queen Community Hospital has been situated in several different locations before coming to its current home on Cole Avenue, including its hilltop perch in this large building. According to Glenda Trevino, RN, nursing education director, the building was later used for housing, but is now up for sale.