Ultrasound at 18,000 ft.

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A brief history of the making of Solar‐Powered Point‐of‐Care Sonography: Our Himalayan Experience (J Ultrasound Med 2019 doi.org/10.1002/jum.14923).

Dr Mark Kushinka and Dr Rob Razick are sitting at camp in Phirste La Pass at 18,208 ft. The camp is designated by banners of alternating color flags attached to the top of a pole and pinned to the ground. Mountains are shown around them with blue sky.

Dr Marc Kushinka (left) and Dr Rob Razick (right)
 in Phirste La Pass at 18,208 ft.

Full disclosure… I wasn’t actually there.  Anyone who knows me knows I am not the “sleeping with yaks, no shower for a month” kinda girl. I also have no shame in admitting that I had no chance of surviving the 80+-mile trek 3 miles high amongst the clouds. Fortunately for me, and the people who inhabit the Zanskar Mountain Range, I had 4 residents who wanted to spend several months hiking through a mostly impassable mountain trail providing care to those who live in this spectacular part of the world. Our Lumify’s passport had already amassed an impressive collection of stamps, but none of them as remote as the Himalayas. There is no electrical infrastructure in this region, and all sources of energy come from kerosene, dung briquettes, or solar power. As Dan and Zac departed for India, we had no idea if this crazy plan to operate the ultrasound solely off of a portable solar pad was going to work. Frankly, I was a bit worried that I was adding a few extra pounds to their pack for no good reason. But, after spending 30 days in one of the most remote locations on this Earth, the guys returned with some great stories, good images, and a ton more facial hair.

Dr Daniel Baker and Dr Zac Hardy are shown standing together in Phirste La Pass by a snow-tipped mountain peak.

Dr Daniel Baker (left) and Dr Zac Hardy (right) 

 As I sat curled up in my leather chair with a supple cabernet, I reviewed the data from their trip and realized just how awesome this was. There had never before been medical imaging accessible at this elevation, and its availability had a direct impact on patient care. We repeated the adventure the following year with a new set of residents and the same cheap solar pad from Amazon. After some minor modifications based on our lessons learned from our inaugural year, Marc and Rob yielded more consistent scan times and reliable use.

I truly believe solar powered POCUS can change the face of austere medicine. All you need is a solar pad, a portable ultrasound, and the desire and willingness to leave the comfort of home. Or at least have a few residents up for the adventure.

Cheers from Kashmir!

Have you performed ultrasound examinations in remote regions? What was your experience? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community. Visit the Journal of Ultrasound in Medicine online.

Laura Nolting, MD, FACEP, is the Director of Emergency Ultrasound and the Ultrasound Fellowship Director for the Department of Emergency Medicine at Palmetto Health Richland in Columbia, South Carolina.

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