Emergency Medicine Bedside Ultrasound (EMBU) is a diagnostic modality deployed in real-time by the treating physician to get immediate information at the bedside about the condition of a patient. Ultrasound applications that assist in the evaluation of time-critical illnesses can de facto only be provided by the treating physician at the bedside. Historically it was this compelling logic — not the cost savings or convenience or avoidance of ionizing radiation — that led to the acceptance of the clinician-performed FAST exam in the 1990’s. With mounting pressures for out-patient management of increasingly complex diseases using potentially more dangerous therapies, the acuity of patients presenting to the ED will continue to rise, and the uses of point-of-care ultrasound in the management of time-critical illnesses are likely to continue to be extended.
In our department, ED faculty has autonomy to perform EMBU to be used in clinical decision-making, as and when it deems clinically appropriate. The credentialing committees at both HUP and PPMC recognize EMBU in both "Restricted" (limited to specific ultrasound applications) or "Unrestricted" (no specific limitation of ultrasound applications) privileges. There has been reimbursement for clinical ultrasound services rendered in the emergency department since the inception of the program in 2001. In the ED at HUP, the ultrasound stable includes an Acuson X-300, a Zonare, an Ultrasonix, and two SonoSite M-Turbos in the ED. There is an additional dedicated M-Turbo in the trauma bay. At PPMC, SonoSite M-Turbos are used.