Utilisation of Focused Assessment with Sonography for Trauma (FAST) in a referral hospital in an acute conflict zone

Introduction The role of Focused Assessment with Sonography for Trauma (FAST) is well described in the literature in high-resource general emergency care settings. However, there are limited data on utilisation of FAST by local providers in limited-resource conflict settings. We describe the first experience of a hospital in E-DRC using the FAST exam in triage to evaluate and expedite blunt and penetrating trauma patients during an armed invasion. Methods HEAL Africa Hospital (HEAL) is a tertiary trauma centre located in Goma, Eastern Democratic Republic of Congo. In 2010, ultrasound training was initiated. During subsequent armed fighting and the invasion of Goma, the hospital adopted the FAST exam as triage tool in the emergency centre (EC). Ultrasound scans were prospectively logged and perceived utility for immediate patient management was recorded. At a 1 year follow-up, a cohort of physician and nurses considered downstream patient recipients were also asked perceived utility towards its use. Results 222/243 (91%) of ultrasound scans were recorded by physicians as having positive utility for immediate patient management. 61/243 (25%) scans were FAST exams; 24 for obstetric evaluation and 158 were scans for pain management with ultrasound regional anaesthesia. 23/61 (41%) of the FAST were reported as positive. Patients with + FAST were immediately prioritised and either a chest tube was placed or taken to the operating room for laparotomy. All 23 patients brought for laparotomy or chest tube were shown to have haemoperitoneum or positive output respectively. Discussion The introduction of FAST training and requisite equipment in resource stressed healthcare settings is both desirable and feasible. In this study, the introduction of FAST by local providers had an important influence on the decision making process and enabled immediate triage of casualties to laparotomy, chest tube or clinical observations. Prospective controlled research is further needed to evaluate the impact.