It's surprising how few posts there are about point-of-care ultrasound use in the ED on the BC Emergency Network. It is entirely changing patient assessment and management in rural BC, with need particularly amplified by COVID-19.

On Haida Gwaii, access to diagnostic imaging entails a 7-hour ferry ride (each way) and between 2-5 nights away from home. Compounded by high rates of COVID-19 throughout Northwest BC and the risk of acquiring and returning infected, the majority of patients are very reluctant to go for indicated formal imaging. There is an imperative to scale and support safe POCUS use in rural BC while looking at ways of improving systems-level supports.

Recognizing its potential, the Rural Coordination Centre of BC (RCCBC) launched the "Intelligent Network for POCUS" - IN PoCUS, where 50 subsidized Clarius handheld probes were distributed to 50 rural GPs with education and support. The Clarius user interface integrates secure cloud image-storage that permits image review by specialists or virtual support tools (like RTVS). Building on IN PoCUS, the RCCBC will be developing a Provincial POCUS Strategy for rural BC. A working group of POCUS leadership will develop a Strategy this year, evaluating barriers to POCUS integration and means of improving its effectiveness and safety. An effective strategy will include a higher profile on the BC EM Network.

The BC EM Network could be a place we share images and clips and discuss the geography-specific role for POCUS in the ED. For austere or remote environments without CT or diagnostic US, nothing improves bedside care more than POCUS. Embedding POCUS into physical examination allows one to look into the body, seeing things that could only have been percussed, palpated or auscultated. Imagine the "rational clinical exam" fully revamped with POCUS integration.

Tracy Morton

Haida Gwaii Hospital & Health Centre