Point-of-Care Ultrasound (POCUS)

Point-of-care ultrasound (POCUS) imaging is an important imaging modality in emergency departments across the globe. POCUS enables emergency physicians to make diagnostic decisions at the bedside and improves the safety of critical procedures. In Addis Ababa, Ethiopia, there is a scarcity of radiologists serving public hospitals and a population of approximately five million people. At Tikur Anbessa Specialized Hospital, the primary teaching hospital at Addis Ababa University (AAU), radiology services are not always available, and when available, often come with delays. Within this context, where formal imaging is unavailable or unaffordable for patients, availability and quality of advanced POCUS training is of great importance.

Through our TAAAC-EM collaboration, we continue to recognize the importance of innovation in POCUS education and have continued to prioritize a robust program of research focussed on the use of POCUS in low-resource settings. Previous successes in establishing a foundational POCUS curriculum for emergency medicine and critical care residents at AAU and in designing an alternative ultrasound gel, have laid the foundation to offer more advanced POCUS education offerings for residents and staff.

We continue to refine and evaluate our POCUS education initiatives, including various ongoing programs like the East African POCUS Training Program Implementation and Evaluation and the emerging Acute Care Echocardiography (ACE) Training Program for residents.

Current Projects

The East African Emergency Point-of-Care Ultrasound Fellowship ("E-POCUS" Fellowship) Program was developed to train a cohort of emergency physicians in Addis Ababa, Ethiopia to be leaders in POCUS. The E-POCUS program is a 12 month hybrid fellowship with four in-person scanning intensive months with supervised scanning. During the other months of the fellowship, fellows engage with virtual quality assurance for their scans, journal club, curriculum design discussion and research planning. While the program itself has concluded, a formal evaluation is now being undertaken in order to 1) assess the impact of the E-POCUS program on participants’ POCUS self-perceived knowledge, skills and level of comfort in using POCUS and in training others, and 2) to utilize feedback on the E-POCUS program’s design, structure, content, efficacy and value to inform future iterations of the program.

The Acute Care Echocardiography (ACE) training program has been designed to train emergency and critical care medicine residents at AAU on focused transthoracic echocardiography. Through structured protocols the incorporation of focused echo in the workup of patients will allow for faster diagnoses and improved patient outcomes. Furthermore, with high prevalence of rheumatic heart disease (RHD) in Ethiopia, learning basic focused echo could allow physicians to detect cases of RHD sooner, allowing for earlier targeted interventions. The ACE training program was piloted in May 2025. TAAAC-EM is currently hosting a STAR-EM/CREMS student throughout Summer 2025 who will be looking at the perceived effect and impact on knowledge of residents participating by evaluating the initial pilot workshop in the program. As a pre and post cohort study, this will be done by analyzing pre- and post-workshop evaluations and knowledge tests to inform future iterations of the workshop.

A research project Surveying point of care ultrasound usage in emergency Medicine by Ethiopian emergency physicians: a national needs assessment is also currently being undertaken. Previous research and guidelines have identified the need for locally relevant POCUS curriculum and delivery methods. This research aims to 1) Quantify the number of emergency medicine practitioners using POCUS in their clinical practice 2) Understand which POCUS applications are most commonly used in emergency medicine clinical practice in Ethiopia and 3) Identify barriers and facilitators to POCUS use in clinical practice. An electronic needs assessment survey was distributed by email and Telegram to all practicing Emergency Physicians in Ethiopia, and the data is currently being analyzed.

Current Project Team

Indy Sahota

TAAAC-EM POCUS Lead

Julia Wytsma

TAAAC-EM Co-Director

Temesgen Beyene

Associate Professor, Emergency Medicine, Addis Ababa University

Tigist Zewdu

Staff Physician, Emergency Medicine, Addis Ababa University

Publications, Presentations & Media

PUBLICATIONS

Cruz-Kan K, Ismath M, Solomon E, Girdler H, Beyene T, Zewdu T, Sahota I. Rheumatic heart disease in Addis Ababa, Ethiopia, and the role of point-of-care ultrasound: a case series. Canadian Journal of Emergency Medicine. 2025 July.
Tadesse AZ, Abicho TB, Alemu DM, Aspler A. Point of Care Ultrasound (POCUS) utilization and barriers by senior emergency medicine and critical care residents at two teaching referral hospitals, Addis Ababa, Ethiopia. Emergency Medicine International. 2023;2023(1):7584670.
Aspler A, Kegel F, Beyene T, Zewdu T, Tesfaye B, McKnight A, Cheung E, Bryan J, Acton C. Establishing a self-sustaining emergency medicine point-of-care ultrasound curriculum in an academic teaching hospital in Ethiopia. Ethiopian Journal of Health Sciences. 2022 May 1;32(3).

PRESENTATIONS

Beyene T, Bryan J, Sahota IS, Nowacki A. Shaping the Future of EM: Leadership, Research, and PoCUS in Global Education. International Conference on Emergency Medicine (ICEM). Montreal Quebec, Canada. May 2025. (Panel Presentation)
Girdler H, Beyene T, Zewdu T, Sahota I. Evaluating the East African point-of-care ultrasound training program: lessons learned and best practices. International Conference on Emergency Medicine (ICEM). Montreal Quebec, Canada. May 2025. (Poster Presentation)
Girdler H, Beyene T, Zewdu T, Wytsma J, Sahota I. Surveying point of care ultrasound usage in emergency medicine by Ethiopian emergency physicians: a national needs assessment. International Conference on Emergency Medicine (ICEM). Montreal Quebec, Canada. May 2025. (Poster Presentation)
Cruz-Kan K, Ismath M, Girdler H, Zewdu T, Beyene T, Sahota IS. How can EM POCUS tackle rheumatic heart disease in Ethiopia? International Conference on Emergency Medicine (ICEM). Montreal Quebec, Canada. May 2025. (Poster Presentation)
Douglas-Vail M, Aspler A, Stefan A, Patel H, Beyene T. An overview of global health and humanitarian POCUS - lessons from the field. Canadian Association of Emergency Physicians (CAEP) Conference. Toronto, Ontario, Canada. May 2023. (Oral Presentation)

Past Projects

Developing an Alternative Ultrasound Gel

Project Team: Margaret Salmon, Christian Salmon, Alexa Bissinger, Mundenga Mutendi Muller, Alegnta Gebreyesus, Haimanot Geremew, Sarah Wendell, Aklilu Azazh, Maurice Salumu, Nerys Benfield

Project Description: This work focussed on projects that looked to develop low-cost ultrasound gel for use in settings where commercial ultrasound gel is cost-prohibitive and therefore scarce.

PUBLICATIONS

Aziz A, Dar P, Hughes F, Solorzano C, Muller MM, Salmon C, Salmon M, Benfield N. Cassava flour slurry as a low‐cost alternative to commercially available gel for obstetrical ultrasound: a blinded non‐inferiority trial comparison of image quality. BJOG: An International Journal of Obstetrics & Gynaecology. 2018 Aug;125(9):1179-84.
Salmon M, Salmon C, Bissinger A, Muller MM, Gebreyesus A, Geremew H, Wendell S, Azaza A, Salumu M, Benfield N. Alternative ultrasound gel for a sustainable ultrasound program: application of human centered design. PloS one. 2015 Aug 7;10(8):e0134332.

Defining Regionally relevant POCUS training for the African continent

Project Team: Margaret Salmon, Megan Landes, Cheryl Hunchak, Justin Paluku, Luc Malemo Kalisya, Christian Salmon, Mudenga Mutendi Muller, Benjamin Wachira, James Mangan, Kajal Chhaganiai, Joseph Kalanzi, Aklilu Azazh, Sara Berman, El-Sayed Zied, Hein Lamprecht

Project Description (Abstract): Significant evidence identifies point-of-care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource-limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high-impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource-rich PoCUS curricula and delivery methods to resource-limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing.

PUBLICATIONS

Salmon M, Landes M, Hunchak C, Paluku J, Kalisya LM, Salmon C, Muller MM, Wachira B, Mangan J, Chhaganlal K, Kalanzi J. Getting it right the first time: defining regionally relevant training curricula and provider core competencies for point-of-care ultrasound education on the African continent. Annals of emergency medicine. 2017 Feb 1;69(2):218-26.

Evaluating a POCUS Scan List in a Resource-Limited Emergency Centre

Project Team: Maja Stachura, Megan Landes, Fasika Aklilu, Raghu Venugopal, Cheryl Hunchak, Sara Berman, James Maskalyk, Josee Sarrazin, Tesfaye Kebede, Aklilu Azazh

Project Description (Abstract): Emergency centres (EC) in low- and middle-income countries often have limited diagnostic imaging capabilities. Point-of-care ultrasound (POCUS) is used in high-income countries to diagnose and guide treatment of life-threatening conditions. This study aims to identify high impact POCUS scans most relevant to practice in an Ethiopian EC.

PUBLICATIONS

Stachura M, Landes M, Aklilu F, Venugopal R, Hunchak C, Berman S, Maskalyk J, Sarrazin J, Kebede T, Azazh A. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia. African Journal of Emergency Medicine. 2017 Sep 1;7(3):118-23.

Presentations

Stachura M, Landes M, Venugopal R, Aklilu F, Sarrazin J, Azazh A. Evaluation of a Point-of-Care Ultrasound Scan List in the Emergency Department at Black Lion Hospital, Addis Ababa, Ethiopia. African Conference on Emergency Medicine (AfCEM). Addis Ababa, Ethiopia. November 2014. (Oral Presentation)
Stachura M, Landes M, Venugopal R, Aklilu F, Sarrazin J. Evaluation of a point of care ultrasound list in an urban Ethiopian ED. Canadian Association of Emergency Physicians (CAEP) Conference. Ottawa, Ontario, Canada. June 2014. (Poster Presentation)

Ultrasound-Guided Regional Anesthesia

Project Team: Monica Liu, Margaret Salmon, Rene Zaidi, Arun Nagdev, Finot Debebe, Mundenga Furaha Muller, Cito Furaha Ruhangaza, Haimanot Emiru, Yonas Belachew, Aklilu Tumebo, Marcus Paoletti, Allan Okrainec, Vincent Chan, Ahtsham U Niazi

Project Description (Abstract): Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia.

PUBLICATIONS

Liu M, Salmon M, Zaidi R, Nagdev A, Debebe F, Muller MF, Ruhangaza CF, Emiru H, Belachew Y, Tumebo A, Paoletti M. Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia. Regional Anesthesia & Pain Medicine. 2021 Aug 1;46(8):722-6.

Funding

We are very grateful for the continued financial support for TAAAC-EM from the following donors and granting agencies (in alphabetical order):

Emergency Department

Emergency Department

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