As part of the 50th anniversary celebration of ACEP, Dr. Liu, chair of ACEP’s Emergency Ultrasound Section, interviewed Dr. Mandavia, a founding member and past chair of the section who now serves as chief medical officer of FUJIFILM SonoSite, Inc., a provider of point-of-care ultrasound machines. Here are some highlights from their conversation.
RL: How did you first get involved with ultrasound?
DM: In 1991, I started emergency medicine training at Los Angeles County University of Southern California Medical Center during the Los Angeles gang epidemic. We were overwhelmed with knife and gun injuries, car crashes, and other emergencies. The CT scanner was on the third floor, three football fields away, and patients often died in front of us with undetected internal bleeding or undetected cardiac tamponade, such as from a stab wound. It was a very frustrating experience.
One day, someone brought in a “miniature” ultrasound machine the size of a small refrigerator. I was fascinated that you could look below the skin and rapidly diagnose conditions we had no other way to detect. I was sold and spent my academic career teaching and publishing about point-of-care ultrasound.
RL: Your publications list literally models how we evolved into where we are today, with major landmark papers on bedside echocardiography and the Rapid Ultrasound in SHock (RUSH) exam. You also proposed some of the first models for physician training.
DM: At that time, I was one of the program directors, so it was my prerogative to require every resident to be trained in ultrasound. We were the first program in the country to do that. Now every U.S. emergency physician is trained in point-of-care ultrasound and dozens of other specialties also use it to improve patient safety, efficiency, and quality of care, while reducing the cost of care.
RL: What were your goals in setting up ACEP’s emergency ultrasound section?
DM: At the time, there were eight or 10 emergency physicians in the country using point-of-care ultrasound and we’d meet at ACEP annually. Working together was extremely valuable because there were a lot of educational hurdles and political barriers. In 1995, ACEP’s board of directors approved our proposal to start an emergency ultrasound section. That was a pivotal moment because the section became a dominant player in spreading and promoting point-of-care ultrasound.
RL: Tell us about your entrance into SonoSite and the premise behind the company.
DM: I joined SonoSite as a medical adviser in 2007 and subsequently became its chief medical officer. SonoSite has a very interesting heritage. In 1996, the Department of Defense awarded a Defense Advanced Research Projects Agency (DARPA) grant to ATL Laboratories (then a large ultrasound company based in the Seattle area) to develop the world’s first ultrasound for the battlefield. At that time devices were often 200 pounds and impractical for deployable military.