UUSSLLSS BBLL11 ~~ PPRROOVVIIDDEERR

UULLTTRRAASSOOUUNNDD

LLIIFFEE SSUUPPPPOORRTT 'USCMC LEVEL 1’ CERTIFICATION SKILL SET

ENTRY COURSE FOR ‘USLS BL1-P’ [ULTRASOUND LIFE SUPPORT - BASIC LEVEL 1 - PROVIDER]

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MMaayy 66--77 ~~ 88..3300 aamm –– 55..3300 ppmm

~~ BBrreesscciiaa -- IIttaallyy ~~

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www.winfocus.org

AZIENDA OSPEDALIERA SPEDALI CIVILI DI BRESCIA

CCOOUURRSSEE DDIIRREECCTTOORR

Luca Neri (Milan, Italy) Cristiano Perani (Brescia, Italy)

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Carlotta Gherdovich (Winfocus Secretariat)

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Luca Neri (Milan, Italy) Enrico Storti (Milan, Italy)

Carmela Graci (Milan, Italy) Cristiano Perani (Brescia, Italy) Giovanna Perone (Brescia, Italy)

Alessandro Radaeli (Brescia, Italy) Romano Fiorentino (Castiglione delle

Stiviere, Italy) Luisa Giuliano (Piario - BG, Italy)

WWIINNFFOOCCUUSS CCOONNTTAACCTTSS Secretariat Office

Via Orefici, 4 - 40124 Bologna, ITALY Tel +39 051 230385 Fax +39 051 221894

secretariat@winfocus.org www.noemacongressi.it

www.noemacongressi.it/english.html

Executive Office – Board Via Borgonuovo, 4 - 20124 Milano, ITALY

Tel +39 333 5404074 Fax +39 02 700531930 winfocus@winfocus.org

www.winfocus.org

RREEGGIISSTTRRAATTIIOONN

““CCRRIITTIICCAALL UULLTTRRAASSOOUUNNDD”” The concept of 'critical ultrasound' evolved recently from 'emergency ultrasound' performed at the 'point-of-care' in scenarios such as emergency departments, ICUs, pre-hospital care, austere environments, disaster scenes, tactical operations, and humanitarian care missions. Clinical scenarios turn into 'critical' ones when there is a dangerous performance gap between the patient status and the resources available for an appropriate decision making and problem solving. In such settings ultrasound point-of-care image acquisition and interpretation, integrated with advanced life support protocols (ACLS, ATLS) according 'ABCDE' and 'Head-to-toes' -type approaches, allows for rapid and effective decision making, enhanced triage, diagnosis, therapy, monitoring, and follow up. Nowadays, that’s approach is also known as ‘Ultrasound Life Support’. This typically occurs in the acutely ill patient (Emergency US) or intensive (Intensive/Critical Care US), and/or where human or technical resources are particularly limited (Screening US, Triage US, Remote US, Primary US).

WWIINNFFOOCCUUSS ((WWoorrlldd IInntteerraaccttiivvee NNeettwwoorrkk FFooccuusseedd OOnn CCrriittiiccaall UUllttrraaSSoouunndd)) The world leader scientific organization committed to develop point-of-care ultrasound

practice, research, education, technology, and networking, addressing the needs of patients, institutions, services, and communities in “critical” scenarios.

WWIINNFFOOCCUUSS VViissiioonn aanndd MMiissssiioonn SSttaatteemmeennttss Improving Primary, Emergency, and Critical Care Medicine, by incorporating "point-of-care" Ultrasound into Clinical Practice … bringing quality “Point-of-care” Ultrasound to the patient

in all out-of-hospital and in-hospital “critical” scenarios, by developing and fostering, on a global and multi-disciplinary basis, Ultrasound Education, Technological Development,

Evidence-based Research, and International Teamwork.

Dott.ssa Carmen Parrella

carmela.parrella@spedalicivili.brescia.it

Ufficio Formazione Aziendale A.O. Spedali Civili Brescia tel 0303849325 fax 0303849300

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AABBCCDDEE UUllttrraaSSoouunndd RReessuusscciittaattiioonn [[EEnnttrryy ccoouurrssee ffoorr UUSSLLSS BBLL11 PPrroovviiddeerr CCeerrttiiffiiccaattiioonn]]

First Day Second Day

08:00 REGISTRATIONS & PRE-COURSE TEST 08:00 REVIEW, DEBRIEFING, Q/A

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08:30 Point-of-care US in Primary, Emergency and Critical Care Medicine: empowering life support protocols

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08:30 ASSESSMENT:

Peritoneal effusion: FAST windows.

08:50 Critical ultrasound techniques: image generation, acquisition, interpretation & administration.

08:50

ASSESSMENT: N/ retro-peritoneal, parenchymal and soft tissue haematomas.

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09:10

ASSESSMENT: Obstruction/atelectasia, tracheal displacement and lesions, emphysema. Prandial status.

PROCEDURES: ETT, crico-tyroidotomy, tracheo-tomy/-stomy.

09:10

ASSESSMENT: Abdominal & thoracic aortic aneurysm: detection, measurement, N/ dissection and rupture.

09:30 MANAGEMENT: Airway Protocols & Interactive Cases [US-AIR]

09:30

ASSESSMENT: O&G emergencies: ectopic vs intrauterine, retroplacentar haematoma, placenta previa. Fetus: movements, heart beat, position, presentation.

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09:50

ASSESSMENT:

Pleural effusion, alveolar consolidation, interstitial syndrome, pneumothorax. Diaphragm impairment.

09:50

PROCEDURES:

Defibrillation, TC & IV pacing.

Pericardiocentesis, pleurocentesis.

Paracentesis, DPL, laparotomy.

10:10

PROCEDURES: Needle aspiration, thoraco-centesis, chest tube insertion, thoracotomy.

10:10

PROCEDURES:

Peripheral & central venous catheterization.

10:30 MANAGEMENT: Respiratory Protocols & Interactive Cases [BLUE]

10:30 MANAGEMENT: Cardio-circulatory Protocols & Interactive Cases [FAST, EFAST, FAST-ABCDE, L/H/CV]

10:50 COFFEE BREAK 10:50 COFFEE BREAK

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11:10

ASSESSMENT: Introduction to echocardiography. Cardiac and caval vein windows.

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11:10

ASSESSMENT: Optic nerve sheath/disc, pupil assessment (+midline shift, cervical fracture, neonatal assessment).

MANAGEMENT:

Neurological Protocols & Interactive Cases [US-NEU]

11:30

ASSESSMENT: Critical hemodynamic assessment: heart morphology/performance/filling state, pericardial effusion/tamponade, caval vein variations.

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11:30

US ABCDE PRIMARY MANAGEMENT:

- US Trauma Life Support [US-TLS]

- US Advanced Cardiac Life Support [US-ACLS]

- US-Triage & US-EMS/HEMS

11:50

ASSESSMENT:

Thrombo-embolic disease: deep venous thrombosis, pulmonary embolysm.

HEAD

-TO-

TOES

11:50

CONCEPTS ON HEAD-TO-TOES SECONDARY MANAGEMENT & MONITORING:

- Head, Thorax, Abdomen, Limbs

- Assessment, treatment, monitoring, and follow-up

12:10

MANAGEMENT:

Cardio-circulatory Protocols & Interactive Cases [FEEL, FATE, L/H/CV]

CME 12:10 Ultrasound education and development: WINFOCUS global initiative for PHC, EM and CCM.

12:30 LUNCH 12:30 LUNCH

TRAINING

13:30

US HANDS-ON & SIMULATION:

[HUMAN MODELS, PHANTOMS & ULTRASOUND SIMULATOR]

Machine orientation.

Signs & patterns, sono-anatomy.

Airway, Breathing, Circulation.

TRAINING

13:30

US HANDS-ON & SIMULATION:

[HUMAN MODELS, PHANTOMS & ULTRASOUND SIMULATOR]

Circulation, Disability

Dyspnea, Shock, Coma

US Trauma Life Support [US-TLS]

US Advanced Cardiac Life Support [US-ACLS]

17:30 SESSION CLOSURE 17:30 POST-COURSE TEST & CLOSURE

CCOOMMEE RRAAGGGGIIUUNNGGEERRCCII:: In auto: uscita autostradale di Brescia Centro per chi proviene da Cremona o da Verona e di Brescia Ovest per chi proviene da Milano. L’ospedale è situato nella zona nord della città, in direzione Valtrompia, ed è chiaramente indicato dalla segnaletica stradale. Per chi esce al casello di Brescia Ovest si consiglia di percorrere la tangenziale ovest. Con i mezzi pubblici: Linee 1, 10 e 15 degli autobus urbani con partenza dalla stazione FS e dall’Autostazione.

SSEEDDEE ddeell CCOORRSSOO

Le lezioni teoriche del corso si terranno in Aula Montini (Satellite) mentre le esercitazioni pratiche si terranno nelle aule del Pronto Soccorso

MMOODDAALLIITTAA’’ ddii IISSCCRRIIZZIIOONNEE::

L’iscrizione dovrà essere effettuata tramite contatto diretto/telefonico/email con la segreteria organizzativa dell’ Ufficio Formazione Aziendale ed utilizzando la scheda allegata. E’ previsto un limite di 15 partecipanti (10 esterni e 5 interni) per garantire un miglior rapporto docente – discenti durante le esercitazioni. Le quote di iscrizione sono le seguenti: Quota di iscrizione 490€ + IVA Quota di iscrizione ridotta per soci WWIINNFFOOCCUUSS o soci SSIIMMEEUU 300€ + IVA A tutti gli iscritti verrà fornito accesso alla sezione online di e-training per fruire del materiale didattico. E’ previsto accreditamento ECM con relativa certificazione.

MILANO

VENEZIA CREMONA

AZIENDA OSPEDALIERA SPEDALI CIVILI DI BRESCIA

UUSSCCMMEE GGLLOOBBAALL PPRROOGGRRAAMM DDIIRREECCTTOORRSS::

Chair: Luca Neri (Milan, Italy) Co-chairs : Richard Hoppmann (Columbia, SC, USA), Enrico Storti (Milan, Italy) Advisors: Michael Blaivas (Atlanta, GA, USA): Winfocus President, RESCUE & ILCEUS Chair

Daniel Lichtenstein (Paris, France): Winfocus Scientific Comm. Chair

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The applications targeted in the USCMC (www.winfocus.org/uscme/uscmc ~ Ultrasound Critical Management Certification) program rely on the most recent literature and recommendations, and refer mostly to the “Critical Care Medicine Journal” Supplement fully dedicated to the ultrasound applications in the acute and critical patients (Crit Care Med 2007;35[Suppl]), written by a few dozens of the actual major world experts in the field,

coordinated by Blaivas, Kirkpatrick and Sustic, and mostly involved in the Board of WINFOCUS. Proposed educational formats and pathways refer to a working document, published in its earliest version in the same

supplement (Neri L, Storti E, Lichtenstein D, Toward an ultrasound curriculum in critical care medicine. Crit Care Med 2007;35[Suppl]:S290–S304), starting point of an International evidence- and consensus-based process,

join to the USCME and ILCEUS projects (www.winfocus.org/rescue/ilceus).

UUSSCCMMCC EEDDUUCCAATTIIOONNAALL CCEERRTTIIFFIICCAATTIIOONN RROOAADDMMAAPP ::

Certification steps are implemented along the three EFSUMB levels of proficiency (www.efsumb.org):

• Level 1 (BL1 & AL1, Basic and Advanced) - Common, general, focused competency

• Level 2 (BL2 & AL2, Basic and Advanced) - Comprehensive, specialized competency

• Level 3 (beyond standards, still to be defined) - Outstanding clinical, educational, research expertise

Each level includes Provider and Trainer competence-based modules (see below as ex. the USLS roadmap):

“ULTRASOUND LIFE SUPPORT” competence-based certification pathways:

• USLS BL1 Provider >> Trainer (“ABCDE” conformed, non-specialty-specific, general)

• USLS AL1 Provider >> Trainer (“Head-to-Toes” conformed, setting/specialty-specific, general)

• USLS BL2 Provider >> Trainer (Problem-based, setting/specialty-specific, specialized)

• USLS AL2 Provider >> Trainer (Organ/District-based, setting/specialty-specific, sub-specialized)

Ex. ECHO-AL2 Provider >> Trainer (Advanced “Echo-Doppler in ICU” competences)

According specific performance needs, several Level 1 and 2 (L1, L2) UltraSound Life Support and Procedural modules are available, both for Providers and Trainers (P, T):

• US-TLS (US Trauma Life Support, ATLS-conformed)

• EFAST (Extended Focused Assessment with Sonography for Trauma)

• US-ACLS (US Cardio-Pulmonary Life Support, ACLS/ALS-conformed) • US-BLSD (US Cardio-Pulmonary Life Support, BLS/LSD-conformed)

• US-NPLS (US Neonatal & Pediatric Life Support, PALS-conformed) • US-PHLS (US PreHospital Care & Disaster Medicine Triage)

• US-Triage (US Triage in Disaster Medicine)

• CC ECHO (Critical Care Echocardiography or ECHO ICU) • US-MON (US ABCDE Monitoring)

• US-SEPS (US Sepsis Management)

• US-GPE (US General Practice in Emergency) • US-PHC (US Primary Health Care in scarce-resource-setting)

• US-NURSE (US Nursing care in Emergency)

• US-AIR (US Airway Management) • US-CVA (US Central Vascular Access Management)

• US-PVA (US Peripheral Vascular Access Management)

• US-BLOCK (US-guided Nerve Blockage)

Note: USLS BL1 Certification includes US-TLS, US-PHLS, EFAST, US-BLS, US-ACLS credentialing.

Each certification module is developed along three learning phases and a final examination:

• Part Ia: preliminary e-learning (lectures, interactive sessions, references)

• Part Ib: 1-2 days introductory course (theory, hands on, and simulation components)

• Part II: 1-6 months proctored practice (specific minimal requirements)

• Part III: 1 day credentialing examination (presentation, questionnaire, simulation-based practice)

Each credential profile undergoes maintenance and quality assurance processes:

• Refresh: 1-2 day course (every 2 years; specific annual minimal requirements)

UUSSCCMMEE AAUUDDIIEENNCCEE TTAARRGGEETTSS ::

- Health care professionals: Physicians, Nurses, Paramedics, Midwives, and Technicians … working in

- “Critical” scenarios: EM, CCM/ICU, Acute/Trauma Surgery, HEMS/EMS, PHC, Pediatric, Sport, Tactical, Remote, Rural, Wilderness, Scarce-resource settings.

Further details at www.winfocus.org/uscme

UUSSCCMMCC CCEERRTTIIFFIICCAATTIIOONN ~~ UUSSLLSS BBLL11 && AALL11 ffoorr PPRROOVVIIDDEERRSS