EMS POCUS Webinar with AI (6/28/24)

Welcome Everybody. It is June 28, 2024. Today is going to be an exciting webinar. We're going to talk about EMS pocus point of care ultrasound in the pre hospital setting. We have a great lineup for you today. We have this kind of stage in a very nice sequence here.

Some of you may be using pre hospital ultrasound. And for those of you who have deployed it, I'll bet you that you'll hear the same story as you're about to hear from my EMS chief at Palm Beach County, Chief Charlie Coyle, where the implementation. You do a lot of training and education and then all of a sudden you recognize that there are some difficulties along the way. We were very blessed to bring in Dr. Hampton when she was at Washu to help train us and we will never forget that experience her and her daughter. She's now been over working on the front lines in Ukraine and now in Germany. But so Kasha at the end. I want to have you comment on all of this, but first let's turn it over to Keith Coyle. Keith, we've had ultrasound at our department for a number of years. Can you just describe what that's been like? What are some of the outcomes and what are some of the areas you think we can perhaps work on to get better adoption?

Hey Dr. Antebe, first and foremost, thanks for having me on the show today. And obviously this is a very hot topic in EMS and it's an honor to be on here. So I will tell you that primarily we only have it on our EMS captains. So basically our EMS captains are our field supervisors that work in battalions, geographical areas. And we do have it on each and every one of our EMS captains vehicles. And we've had some phenomenal cases. The one that is probably the most prevalent that I'm aware of is, you know, a child that's in cardiac arrest. The EMS captain makes a decision to ultrasound, you know, a nine month old child to see if there's any activity, you know, of the heart and essentially withholds the epi, does some cpr, gives some fluids and the kid has a great outcome and neurologically intact. Right. But I will say there are challenges with that. So great case we have, you know, at a 35 EMS captains, we have some that, that won't get off the truck without it. And then I have some that probably wish that they never even had it on the truck to begin with. And it's not because they don't want to use it or they don't believe in it. It's really because of the training and continuous quality management behind it. So we were blessed for training. Right. You, when you purchase this equipment, there is training, you know, by the vendors. They'll come out and do some training for you. Dr. Hampton did come down and train all of our supervisors and she was amazing. I can't thank her enough for her services and coming down and educating us. And Dr. Farsi and Dr. Drou, we do recurrency training, but the problem is if you don't have a quality management program set up, they don't have confidence in it. So if they don't have confidence in it and they're not using it on every patient, it becomes one of these novel concepts to certain people that are scared to use it. So we kind of, you know, we started with a heavy protocol and actually backed down the protocol a little bit to make sure that we didn't give them too much of an expectation and then not do it and, and then be legal ramifications on the backside. So, you know, I will say that training is paramount, A quality management program is paramount. And then making sure you have a protocol that fits all of what they're being taught, I think that's very important.

Wonderful. That was a great, great scenario and great summary. What I'm going to do is I'm going to bring in Tanner. So many of you know, Tanner and I are now co hosting this podcast together. Tanner is an MD, PhD student in West Virginia and he's a savant when it comes to EMS research. So Tanner, I asked Tanner to put together just a little bit of the research, pre hospital research that's been done on EMS Focus to give us a little bit of a taste of what's out there. And then we're going to move into a very exciting aspect of the, of the talk, which is maybe the future that's already here. So, Tanner, take it away.

Sure.

Yes. So I think to start with, the first thing I like to do is kind of highlight the variety of things that ultrasound is being used for in the pre hospital setting. Right. This is a, this is a versatile tool and there was a, there was a narrative review that was published in 2022 in Pre Hospital Emergency Care that looked at all the literature that's out there about pre hospital ultrasound. They found about 300 papers. And you know, when it comes to use cases, you can really divide the use into, into two categories. So there's diagnostic uses. Right. So, you know, again, looking for a cardiac standstill for cardiac arrest to inform those termination or treatment decisions like Mr. Coyle mentioned for trauma patients doing the FAST and E FAST exams looking for sequelae of trauma like blood in the abdomen, pneumothorax, pericardial tamponade, those sorts of things to guide triage and maybe even treatment. Lung exams for respiratory distress patients made up a sizable chunk of the literature looking for BE lines trying to differentiate pulmonary edema from maybe kind of chronic obstructive pathology. There's even some evidence out there that using transcranial ultrasound can be used to identify patients who are suffering from large vessel occlusion strokes as well. And this is probably more relevant, relevant to kind of critical care transport, but it can also be used in obstetrics to look at fetal heart rate and kind of related metrics. And it can also be used for procedural guidance. So there's a fair number of papers out there looking at using ultrasound in the pre hospital setting for difficult vascular access both on the venous side and arterial lines to kind of get continuous arterial pressures and blood gases and those sorts of things, as well as nerve blocks. There's definitely some case reports about pre hospital pericardiocentesis as well as hand positioning during cpr. So there's some literature out there that shows that compression of the left ventricular outflow tract compromises hemodynamics and is common. And so maybe ultrasound can be used as a tool to kind of guide compression position on the chest and improve outcomes. And so I think there's a lot of places in EMS where this could be useful. It could impact patient oriented outcomes and improve systems of care.

And so that's kind of what it can be used for. But there's also a lot of problems that were highlighted in this review and in the literature. And so there are also different strategies that are being employed. So some systems, primarily systems that are kind of physician staffed. So in Europe they have a lot of physician staffed units. All the images and the treatment decisions, it's all being interpreted by the people doing the exam. But then also in the literature you see that there's a lot of programs where transmission of images is being attempted. So either capturing static images or recording videos that are being transmitted in real time for interpretation by a sonographer or a remote physician position.

You know, along with these different strategies, they require obviously different amounts of training. Right. Allowing people to interpret their own images and make decisions is going to require much more intensive one on one training. It's going to require kind of structured and objective assessments, ideally kind of on a regular basis, as well as you know, a big time commitment. Right? You have to spend time with patients, you have to spend time in the hospital, do it on a lot of patients. Right. Of course, you know, it's how we learn any clinical skill. If you want to learn how to, you know, listen to breath sounds, instance, you have to do it on a lot of normal patients before you understand how to identify pathologies.

And, and so, and so then there's also some problems that go along with this. So, so of course EMS systems nationwide are strapped for cash often and that has relevance to whether or not we can purchase these devices. And it also has relevance to whether we can actually perform adequate training. Right. Training's not free. It, it involves a large time commitment. It involves purchasing of, of models that involves people's time. And so that's one limitation specific to the EMS practice environment. There's a couple of papers that specifically speak of vibration induced artifacts. You know, as you're doing ultrasounds, bouncing down the back of a road in the ambulance or flying in a helicopter. It's a specific problem that can kind of impact image interpretation as well as the ever present problem of skill decay. Right. This is, this is, you know, a problem with every skill that we teach pre hospital providers to perform, whether it's vascular access or medication math, skill decay is going to be a problem here as well. And so, you know, the question is, you know, in a resource limited setting with ems, how do we address some of these problems? And one problem that has been partially addressed by the vendor that's going to be speaking today is using AI, using kind of machine vision, machine learning, in order to help us perform ultrasound, help us kind of capture images that are of diagnostic quality and perform this procedure and kind of circumventing problems with skill decay, et cetera.

That was a great review to write. So this is something that came to us here in Broward county with a presentation here locally and it's something that we thought was very interesting. Interesting enough that we actually had a preliminary call with Luke Baldwin, who's going to be our next presenter with, with I keep saying it right? Econos. Am I saying it right?

Yeah, that works.

Okay.

So this is fascinating and I think this could be the future. So Luke, if you wouldn't mind sharing your screen, taking us through what, how Equinos is different and how it could potentially in my mind, provide that assistance for the provider in the field so that they know what they're looking at and then potentially one day that image could be sent to the cloud and then sent Back to us with a diagnosis perhaps. But Luke, take it away. Thanks for joining us.

Yeah, absolutely. Thank you so much for having me. So I'm Luke Baldwin. I'm the VP of marketing for Econos. I oversee the global marketing organization, which includes product management and all of that as well. So we're looking at the roadmap right now, which I will say is very exciting. So I won't get into that quite yet. But what is Econos? How are we different? When we developed Cosmos, what we had in mind was breaking up the paradigm. So what we have seen in the world of ultrasound so far is you have handheld ultrasound systems, you have CART based ultrasound systems. And.

The way the world works today is if you have a handheld, it's highly high portable, it's affordable. But you, you compromise on image quality and capabilities. If you have a CART based system, obviously you're not throwing that in a helicopter, you know, but you have the highest quality image. But it comes at a price as well. They're very expensive. So when we developed Cosmos, we combined both of those. So Cosmos is a hybrid. We've got the image quality and the capabilities of a high end system that you would find in a, you know, in a hospital. But it's, it's as simple, as portable, as capable as, as affordable as a handheld system.

As for our product, let's see, it's not advancing. There we go. We have two different probes. So your cardiac probe on the left, cardiac, abdomen, lung, your linear probe on the right here. For, for everything else, if you're doing vascular access or needle guidance, that would be your choice there. These are very, very durable, drop tested, five year warranty built for the military. So really designed for the point of care environments, wherever that may be. And one of the things that sets us apart beyond all of that is our AI. I'm only going to show you a glimpse of things that I think are relevant for this audience. The first thing would be really going to. What you pointed out, Tanner, as a big barrier is training. And so we, we built a product called Trio. This is, this is built into the system itself and there are really three things that are happening all at once. Or you could choose just one layer at a time. You have onboard guidance that are, that is going to guide you and where to place the probe to get the ideal image. So this can be done, you know, in between shifts or you know, on a, or here that to, to build that muscle memory, you've got grading, which helps you orient the image you're seeing. And Understanding is that diagnostic quality or not? Everything looks gray and white and black. What, what's diagnostic quality? We're going to grade that image for you and show you the more green bars. You know, you've got a great image. And then labeling, which is something that I know a lot of people are using just by itself, just for orientation sake. So it's going to label the anatomy in real time as you're examining. So if you're looking for the heart during a, you know, while that Lucas device is going, you can, you can see the structures, you can see the heart. So when you, when you're for pulse checks, you're, you're right there. You're right. Ready to go.

We have an auto ejection fraction capability which I won't go into, but there's been some research on this on the hospital side and it's very, very, very promising, very interesting stuff. And it utilizes those three things all at once as well to guide you to get that ejection fraction of the heart.

AI FAST is especially interesting. So this is a labeling of the, the entire anatomy for what you would if you were to conduct a FAST exam. So you can see it's labeling the liver, the hepatorenal space where there might be a collection of fluid and a positive fast kidney, diaphragm. So you've got, this is happening in real time. You're getting those.

Those labels for orientation and education. So this is education that goes with you, right? It's, it's something that, that goes with the system. Here's another one that's very helpful for your multi organ exams like a FAST examination.

One of the most important things when you're learning ultrasound is to ensure that you know, you know to have the highest accuracy and, and the best image quality. So again you can know what you're looking at is to make sure that you're in the correct preset and when things are, when time is rushed, when you're doing a multi organ exam, you know, reaching up and changing the preset for the anatomy you're scanning can be one extra step. So auto preset is, is our step towards where we eventually want to go, which is touch free scanning. So what the system does is, recognizes the anatomy you're scanning and it automatically optimizes the image for the correct preset and the depth that you're looking at. So this is again, it's saving time. It's, it's one less step that you have to worry about.

And then there's some hospital research that has been done with our system in particular. And I won't go through every detail here for time's sake, but we're getting high marks on not just, you know, the system quality. The, you know, as I mentioned, it has, you know, we're, we're benchmarked against CART based, high end, you know.

$70,000 plus systems, but also our AI is being researched and is showing. In this first case, this was done in Stanford with a group of novice users. Both of these focused on novice users. This first study looked at an AI group. In this case, they used a butterfly system and then.

The AI group using Cosmos and the non AI group using a butterfly system. They compared the two groups on a few different measures and the AI group performed extremely well comparatively. So you had 30% reduction in scan time to get the image and they doubled their image quality scores compared to the AI group.

Correctly, the number was double, I think of almost double of being able to correctly identify the LvsF.

Compared to the non AI group. And then the students, this is an interesting one as well. In the AI group, they reported using the device more frequently than the non AI group. And we think that has something to do with, you know, their.

Comfort level of having that AI to kind of provide that, that guidance. So there's further commentary there. And just to finish up, you know, this is, we're just getting started. We've, we've been hammering.

The technology and really pushing the envelope since 2020. And we're, we're not slowing down. So we've got some very exciting features coming out the rest of this year, some new things coming out next year. You know, we're made in the usa. We're, you know, we're, we're in it to win it. It's a, it's a very, very exciting time to be in ultrasound and we're happy to be leading the way.

Well, that was great. Thank you for a great overview. And obviously, just so people know, you know, Luke was very kind. I, I actually asked him to come onto the webinar and provide just a quick overview and some data. So thanks for doing that. Obviously, there's no conflicts here. I wish we had conflicts, but we don't. And then. Let me see Tanner, are you still there?

Think I lost you. Let me see if we lost Tanner or not.

Looks like Tanner got bumped off. But what I'm going to do now is I'm going to bring in Dr. Hampton. So, Kasha, you are an ultrasound guru. You know how difficult it is for people to actually not just Learn it, but retain the skill. Then do the CQI and have the outcomes.

What do you have to say? First of all, what Chief Coyle mentioned and then if you wouldn't mind even mention commenting on what the presentation you just heard from Luke.

Absolutely. Thank you so much for bringing me on and it's an absolute pleasure to be part of this webinar. You know there is ultrasound in ems. That has always been my passion that it will always be my passion. Although I have to admit you that when Chief Coyle said it's such a hot topic, my first thought was and it's a hot mess at the same time. In fact I was just at a conference conference in Poland speaking to a couple, you know, to some EMS folks because recently as in March, there was a big grinding between the Polish physicians and the Polish paramedics and them trying to pretty much forbid them from performing pre hospital ultrasound. And what did it come down to? It came down to lack of competency and appropriate education. And this is a mistake we keep making over and over and over again. We try to approach in ems. Ultrasound is yet another hot gadget that you're going to go to an EMS conference, somebody will show you look what it can do. Then we trying to bring it on into an EMS agency. We get one course, a couple hours of training and then we try to run for the Olympic trials. Right. And Olympic trials is using the ultrasound immediately in cardiac arrest. And that's a mistake. It's a mistake because that's not how we learn. It's not anything that is being taught or learned this way. And I think what we need to, we need to stop for a moment and first of all define you know, from basing education wise but also research and development. Let's start with education. First of all, let's define what's competency in ultrasound come to be. When you are the competent pocus user it means that you know how to that you can define the indication for a given study, that you know how to do it technically correctly and you know how to interpret it. And then what's the most difficult part of it? You know how to apply that interpretation to your specific clinical setting. Let's not forget that actually in focus, the same picture, the very same interpretation make, let's make it easy, make it a positive pascan. This can have a completely different.

Use depending on your environment. So for example, if you're in pre hospital environment and you see a positive fast scan in an unstable patient, okay, you can give them blood. What can you do you can push on the gas pedal faster and drive, connect, you know, the. Notify your trauma center and get there much faster than you otherwise would. But when you have the same positive fast skin in, let's say, ED setting, right, depending on patient stability, you're going to make some different decisions. Whether you know, whether you're going to do additional imaging, whether you're not going to do additional imaging.

If the patient is in the ICU and he is slowly, let's say, becoming more ticardic, it's a trauma patient that's being observed. And slowly, I don't know, patient with a splenic injury that surgeons decided to treat.

Conservatively, Right. And the patient is becoming somewhat diacardiac, maybe more unstable, and you're trying to determine is there more fluid or not? Am I still sitting on this patient? Or maybe I need to go for interventional radiology or, or to the operating room. So that really, that environment really determines what you're going to do with that information. And understanding the limitation of your environment, understanding how that interplay between pocus and your is an essential skill. And how long does it actually take to become competent in po? Obviously it varies from person to person, but just to give you a rough idea, so there was this really cool study where they have looked at giving a short pocus training on the FAST exams to emergency physicians. And then they followed them for the first 70 scans. And what turned out that the first 10 IFAS scans performed after training where 50% incorrect when it comes to either in, you know, interpretation or, and, or their technical qualities. So, you know, 50 incorrect, that means you might as well toss a coin.

How long did it take them, you know, to really up those skills after 70 scans? And here an important thing, and it's something that Chief Go also mentioned, quality assurance and quality improvement. Every single one of their studies was assessed by an expert user, by a Focus expert, and they received feedback on it. And that's an essential part of focus education. So after those 70 scans, their rate of poor quality scans, whether interpretation or technical quality wise, went down to about 5%. So what does it mean for us? Well, indeed, it means that when we introduce education, that cannot be just, oh, I'm gonna do one course, one and done. No, that's not how that works. It requires longitudinal education and it requires quality assurance, quality improvement process. But here's the thing. Way too often we're attempting to run a quality insurance, quality insurance, quality education improvement processes by people who are just core EMS people. They have some ultrasound skills, but Just for comparison and I said it before one of your webinars. It takes about, you know that it takes reading hundreds of scans every time to, to really have a good eye for picking up on those mistakes and problems and issues quickly and assessing and you know, correcting them in a timely and a time efficient type manner. So that's why it would be way more productive to have quite, you know, to take trained pocus experts and teach them some basics of EMS to understand what they're dealing with like a, like a.

EMS crash course, almost like an EMS medical director's course but obviously in a nutshell in a much.

More focused way for the, for the pocus experts and teaching them that so they would, and they would translate their knowledge and their skills for the EMS environment just like I did in, starting in 2015 when I became working with the U. S. Special operations community. Obviously I am not Mel, you know, @ that time wasn't military, I wasn't, I've never been deployed. That, that has changed in the meanwhile as you know, months in Ukraine. But, but at that time I had to learn from them how to do it and then translate my knowledge. And when it comes to research, one quick, one quick maybe remark over here. When I look at the research studies in mass we go way too often for the low hanging fruit just because it's easy to research. But as we know it's not, you know, it's about. It's not always that what can be counted that matters. Right? And that counts. So we really should stop going for the low hanging fruit and researching for the MTF time that yes, paramedic can be taught how to recognize lung sliding.

We should really refocus our research question. And this must be an interplay between pocus experts, but pocus experts who have been sensitivized to the EMS environment and the EMS people because asking the right question, just a simple example, what is the biggest highest liability that we have in EMS are refusals. And the refusals means, let's say a young healthy woman who is calling for oh I have abdominal pain and now she doesn't want to go because she feels better. And she had a negative pregnancy test at home. We know that a rapture ectopic pregnancy can have a negative rean pregnancy test. But if you see that she has free fluid in her abdomen, are you going to leave her there or not? Well, obviously not. So at least to convince her not to stay at home. So this is, you know, this is really honing those focus and those focus research questions to what is needed in the EMS environment. Not just researching something, because it can be researched. It does not necessarily contribute anything to what we're trying to do. And that's, and that's, you know, in a big sum up. So let's.

Let'S. Akasha, I gotta, I got, I have to stop you because I want to get to, I want to get to Tanner. But that's a perfect segue right there. And I'm not sure if Tanner can come back on because that is the next question for us is, you know, you see a great device. Luke just showed it. It seems amazing. And I have. Dave, I want to have David Long come in. That's why I gotta, I had to cut you off there real quick. But Tanner, I'm not sure if he's still available, but can you give us a couple of sentences here like springboard off of what Dr. Hampton said regarding research? Where are we, where do we need to get to in EMS with respect to research.

In your, in your opinion? So I'm not sure if you're, if you're not there, I'll just go right to.

David. Yeah, absolutely. Yeah. If you're able to hear.

Me.

Yeah. So I think that especially when we're evaluating new devices for doing pocus in the pre hospital setting, we certainly need some, some proof of concept work looking at, you know, sensitivity, specificity, positive predictive and negative predictive value in the pre hospital setting for the specific kind of diagnostic categories or, you know, kind of procedures we're performing. We need to be able to evaluate that in a prospective manner, you know, especially when we're talking about new technology. And you know, ideally it would be kind of comparative work to show, you know, for example, this, this product that uses AI, is that actually enhancing paramedics ability to perform focus in the pre hospital setting more broadly speaking? Another thing that I think is striking about the, the pocus literature is we need evidence that pocus actually improves any patient oriented outcomes. Right. Or impacts the ability of kind of systems of care, whether that's for stroke or trauma to function. Because, you know, that evidence would really provide us with the kind of impetus to spend the money and the time and the resources to really roll this technology out across EMS systems in the United States and.

Worldwide. Perfect. Perfect. And that's a great thing that I think, that I think hit the nail right on the head is that we need EMS based literature. And Tasha mentioned that as well. And she said maybe not just the same old research over and over again, but maybe something else. So now we only have a few minutes.

Left. AI moving ambulance. Let's try.

That. There you go.

I want to bring in our good friend from the Tidewater EMS region in Virginia, David Long. If you don't know David, the guy gets stuff done, let's put it that way. He's done whole blood, he's done many, many things. And then when I put this on Social today, he's like, hey, Doc, we use Cosmos, which you just saw, Luke. So I said, you know what? I'm going to bring David in, and I'm going to David, tell us how it's going and what your feedback would.

Be. So we spent about a year researching devices, and I think part of their conversation, you know, that landed us squarely, you know, in the, in the Cosmos arena was. Was really tied.

To.

The way.

That we progress as an EMS system. Meaning that if you think back to when we first started doing 12 leads and how we are interpreting 12 leads, you know, we rely on algorithms that, you know, the different manufacturers provided. That was kind of a safety net, if you will, until our providers developed the skills to really read 12 and 15, you know, lead well. So we applied essentially that same concept here, is that by having the artificial intelligence available.

We felt that that provided that safety net again for providers, you know, and as well as we talked about that, it's not just the providers, but also the physicians, you know, with, with what information is being, you know, communicated. And with the advancement in the technologies and the fact that now we can actually upload and transmit these scans, you know, as we are interacting with the patients for, you know, for physicians to review, I think that even, you know, more.

Influenced, you know, our direction. So we, we've developed a program, so we, we have a didactic program that we put our providers through with it, then they move into a clinical.

Component that essentially allows. We're using the emergency department, the icu, to basically conduct scans. So we have three different scans that they're required to do, and they have to do 20 scans, you know, of each type. So a total of 60 scans. And then we put them through essentially like an. An oral board process. So they'll come in, they'll read some scans in front of physicians, they'll put them through a couple of scenarios, and then the physician is determined to release them to function. But the ongoing education and training, you know, as previously mentioned here, is extremely important. So.

Yeah, we're, we're excited. We think that this has a lot of potential.

Right?

We. One of the things that we feel like we really may provide some assistance for is how we're doing sepsis care. I mean, when you can see, you know, IVC and determine really that your patients need fluid, you know, whether we get to plasma, you know, is the preferred, you know, administration, or whether we're sticking with crystalloids, you know, for the time being. But again, something else that just, you know, works us through that.

Process. So two things. Two things. I. I heard that there's already the basis of a publication in there. Right. Because you're putting medics through 60 scans and then you have a testing out process.

Right?

Yeah. So that you should definitely publish that. If you need help or assistance, call me. And then the other thing is, have you launched this yet? I mean, are there people out there using the device.

Yet? So our devices. We just. So we've had one of our devices. So Luke and company. So we have four devices in region. We're starting a first class, actually. We'll start in August. We'll put our first 20 folks through. So I anticipate we'll be doing a second one quickly on the heels of that, we're kind of mirroring this with our blood program. So as our blood program expands, we're basically replicating ultrasound and moving in those directions. And just one, one last tidbit. So we got our local school, so Eastern Virginia Medical School is in our region right now. They're getting ready to link up with Old Dominion University as they basically combine the programs. But they have an EMS fellow program. And one of the things we're doing with them, they're actually doing a study now with EMTs that are going through their initial training, and they're essentially evaluating their ability to read scans when provided education. So we're excited to see what comes out of.

That.

That's. And you know, Luke and Tanner and I spoke the other day, and this is exactly the kind of stuff it goes to. What. Towards what Kasha said. Because, you know, listen, we cannot replicate Kasha into every department. It'd be nice if we could. But the question is, and goes back to Luke's commentary, which is how do you give a device to somebody, a novice, and they already have potentially the same or better outcomes than people who've been trained in ultrasound for a long time. So I'm going to go around the horn and I'm going to give. Let's go to Luke and then Kasha and then Chief Core, if you want to make some final comments. We'll kind of circle the wagons and then we'll get over to Dr. Pepe's webinar. So, Luke, give us your final.

Comment. Yeah, I think it's super encouraging to hear everyone talking. You know, our perspective. You know, as a manufacturer, we can't obviously practice medicine, but what we do really well is we hyper focus on what are the barriers that prevent medical professionals from delivering better care. And there's a number of barriers. You guys face them every day. And then we look at what are those. Those barriers that we can. Can focus on. And for ultrasound, the number one barrier has always been education. You know, people don't.

It's not intuitive. You have to learn how to use it. You've got to learn where to place the probe. What are you looking at, how to interpret that. And.

You know, that that's one area that we see. AI has a, Has a role to play. It's a, you know, AI for us, it's not just a thing to do. It's. It's a problem solving mechanism. So that's one reason we're focusing on it. And then once you get proficient at it, the next problems that we're really looking to solve is how do you make that ultrasound exam the most efficient possible. How do you get from point A to point B in the. In the quickest, most accurate way possible? And that's another big role that AI has to play and something we're really focusing on. You know, people pick up the ultrasound system not to use it, but to get an answer. And so if we can help them get to that answer as quickly as possible, that's another. Another big focus for us. So things like EF automating those things, taking away button presses that you would normally have to do as a user, AI can take care of that. So, yeah, we're really.

Excited. Perfect. Looking forward to what that future holds. Let's go to Dr. Hampton and then we'll finish off with chief.

Coil. So as much as I, you know, of course ultrasound is. Has a lot of technological features and it's fantastic and amazing. But I'm still gonna hammer on the fact let's not try to replace proper education and proper research where people. Because we. We cannot keep creat, you know, without your sound, we cannot. It's actually a mistake that was made by my Polish colleagues that been trying. Oh, I'm gonna teach you fast Fuel Blue. Bam. Go. Yes. No, that's. That's what actually promoting this kind of thinking. The ultrasound, the a algorithmic tool. That's not an algorithmic tool. That machine does not have a brain, you gotta use your own. And, and that, that education and the longitudinal education and quality research. But research focused on EMS questions and the right questions which differ from questions in hospital. That is absolutely the.

Key. 100 and I agree that continuous training and CQI, anything you do, I agree with you, has to be done. So with that beautiful segue, let's get it to the guy who could do everything and the guy who launched Cold Blood at our agency and many other things. Chief Coyle, what are your final.

Comments? My final comments are just. What an honor it was to be here. I think it was a great conversation today. I appreciate all the presenters because I learned a ton here. I've got a page full of notes. If you could see what's sitting next to me. And as I hear the conversation between AI and not AI and and learning the basics, I almost feel like I'm reliving innovation, where you have a direct and then you have video, you know, and how you really have to know both of them. And honestly, it's true. And I believe it's true for both of these as well. So I look forward to the future, obviously. I think this is great conversation today and I hope I'm a part of future conversations to make it better for our organization, but also all the other EMS providers on the line today. So again, thank you. What an awesome, awesome, awesome webinar. Once again, Dr.

Entebbe. Way to put the cherry on top, Chief. Thank you so much. And I know Tanner is in some WI fi area issues, so he can't. I don't see his video. But for myself and Tanner, thank you all very much for the presentation. And we're going to put this up on YouTube. Thank you all, everyone. The CME codes are in the chat. And please join Dr. Pepe's webinar, which is in progress right now live across the country and the world. So thanks everybody and we'll see you next.

Week. Thank you.