MINI PROJECT-I (KMBN 152)

Submitted in partial fulfillment of Master of Business

Administration

Session- 2020-2021

“RSS MODEL”

Faculty Guide: Submitted By:

Chandra Kumar Dwivedi Ravi Bajpai
Sumit Gupta
Shubhendra
Department of Business Administration Roll.no.
27580

PSIT College of Management

Affiliated to Dr. A.P.J. AKTU
 DECLARATION

I hereby declare that this submission is my own work. It contains no

material previously published or written by another person, nor has this

material to a substantial extent been accepted for the award of any other

degree or diploma of the university or other institute of higher learning.

Ravi bajpai
 ACKNOWLEDGEMENT

Research Project Report is the one of the important part of MBA

program, which has helped me to gain a lot of experience, which will be

beneficial in my succeeding career. For this with an ineffable sense of

gratitude I take this opportunity to express my deep sense of indebtedness

and gratitude to Dr. Ashok Kumar Tiwari, Director PSITcom and Mr.

Durgesh Agnihotri, Head of Business Administration Department,

for their encouragement, support and guidance in carrying out the project.

I am very much thankful to, my Project Guide Chandra Kumar

Dwivedi
Faculty – MBA Department for his interest, constructive criticism,

persistent encouragement and untiring guidance throughout the

development of the project. It has been my great privilege to work under

his inspiring guidance.

I am also thankful to my parents and my friends for their indelible co-

operation for achieving the goals of this study.

ABSTRACT

In developed countries, the economic feasibility of using ultrasound and CT scanner in

ambulances before arriving at the hospital has been achieved through comprehensive studies,
and this of course does not apply in India, as there are no current studies to support this.
Therefore, this study is a preliminary measure of the economic feasibility of using ultrasound
in ambulances in India. An ambulance equipped with everything a typical ambulance has, but
also a CT scanner and CT tech to operate it, a blood lab, a neurologist, critical care nurse, and
a paramedic. The technology is exactly new, and CT equipped ambulances . 

AIM
Application of ultrasound devices and CT scanner in ambulances with a new model and
providing home medical services in India.

Core Tip: Ultrasound is a non-invasive method, which is useful and effective for both
traumatic and non-traumatic conditions. Therefore, more studies are urgently needed for rapid
diagnosis using ultrasound and CT Scanner before hospitalization, specifically for
emergencies. In fact, diagnoses have not yet been extensively made using this method prior to
hospitalization. Most studies refer to comfort samples and trauma patients, often by pre-
hospital or critical care physicians. The importance of the presence and application of these
services in ambulances provides us with a new model for the introduction of new
technologies in the future that contain ultrasound and CT Scanner for possible early diagnosis
and to then send patient data to the relevant hospital before arrival and provide home service
to patient.

INTRODUCTION
Ultrasound is a Radio graphic modality featuring non-ionizing radiation equipment.
Previously, it was mainly available in hospitals for extensive investigations of obstetric,
vascular, and abdominal diseases.
A computerized tomography scan (CT or CAT scan) uses computers and rotating X-ray
machines to create cross-sectional images of the body. These images provide more detailed
information than normal X-ray images. They can show the soft tissues, blood vessels, and
bones in various parts of the body. A CT scan may be used to visualize the:
 head
 shoulders
 spine
 heart
  abdomen
 knee
 chest

The localized utility of this specialized equipment was due to its massive size that
complicated its delivery from one site to another.
During the 90s, it was transformed to a small portable lightweight ultrasound and CT Scanner
machine with high-resolution images by several medical imaging companies.

This modern radiographic modality has progressively extended its practical use outside
hospitals and is known as "pre-hospital ultrasound".

Qualified technicians and emergency practitioner utilize this technology in critical cases, such
as pleural, peritoneal, and ectopic pregnancy rupture. This is successfully carried out in
private ambulances typically in several developed nations, such as the United States,
Germany, France, and Italy.

Practical experience has demonstrated the significant role of this modality in private
ambulances. It has been extensively reported that unanimously adopting this mobile
technology enables accurate interpretation of unclear questions at the scene, which would
accelerate the continuous process of accurate diagnosis and better patient outcomes in
appropriate time sensitive emergency conditions.

Although there are a modest number of comprehensive studies which have investigated the
economic feasibility of using prehospital ultrasound and CT scanner in private ambulances in
developed countries, there are no studies in Asian nations to adequately support the use of
ultrasound and CT scanner in ambulances. Therefore, this is a preliminary study on the
economic feasibility of ultrasound and CT scanner in private ambulances in INDIA.

The primary aim of this study is to measure the economic demand in Indian ambulances
for Ultrasound and CT Scanner equipment. Other aims include:
(1) to determine the background regarding these equipment in Indian society
(2) to identify the extent of support in paramedics for deploying these equipment in Indian
ambulances.
(3) to investigate the economic feasibility of leading providers (paramedics) to learn how to
correctly operate ultrasound and CT Scanner equipment in private ambulances.
(4) to realize the potential utility of prehospital ultrasound and CT scanner in traumatic and
non-traumatic cases.
(5) to determine its role as a direct communication tool between the private ambulances and
local emergency departments.

MATERIALS AND METHODS

This extensive study was conducted to assess the economic feasibility of gradually
introducing ultrasound devices and CT scanner devices into private ambulances in India. The
participants were distributed over two specific sections to include local hospitals and the local
public. The first sections, respectively, included skilled radiation technologists, emergency
physicians, paramedics and the second section included the local public.
Objectives of the project

This model combine the varied skills and resources of partners in innovative ways and allow
for the sharing of benefits, risks, and responsibilities.
1. Provide Diagnostic service by tapping the expertise of the private sector
2. Speedier diagnosis, reduced incidence of complications due to delays in diagnosis
3. Improved ability of the public health system to respond to health needs of the people
4. Increased confidence of the community in public health services and improved
5. Utilisation of Rural Hospital /Block Primary Health Centres services
6. Increased access of people to improved quality of diagnostic services at affordable costs
7. Reduction in upstream treatment costs of complicated conditions resulting in financial
savings to the government, which can be channeled to preventive healthcare
8. Mobilize private capital to speed up the delivery of infrastructure and services and
eliminate subsidies
9. Enable efficient use of Diagnostic service by improving the identification of long-term
risks and their allocation, while maintaining affordable tariffs
10. Provide higher quality of services
11. Access best practices
12. Enable regular maintenance and upgrades

Factors that influence the inadequate availability of diagnostic services are

1. Non availability of modern automatic and semi automatic equipments which

increase efficiency of the output
2. High capital cost of high-end equipments required for advanced tests
3. Shortage of skilled manpower for operating the diagnostic centre
4. Insufficient supply chain and logistics of consumables and other chemicals
required for the service
5. Inadequate resources to meet the diagnostic load of the hospital
6. Lack of standard operating procedures for sample collection, management,
testing, reporting, patient management and infection control
7. Inadequate bio medical waste management practices
 This model has been designed on the following guiding principles
1. Cost effectiveness: For sustainable partnership, the diagnostic centre must be
viable and at the same time affordable.
2. Comprehensive coverage: Services must cover all the basic categories of standard
diagnostic tests like pathology, clinical pathology, bio-chemical, haematological,
microbiological, serological, and radiological.
3. Acceptable Quality: The operating procedures prescribed by the Government,
must be followed for good quality testing accompanied with compliance monitoring
and timely reporting
4. Upward and Downward Linkage: Non-standard and special tests to be made
5. available through seamless linkages with designated referral laboratory.

The mutual benefit arising out of the project is described as below

S No Stakeholder Benefit
1 Benefit to Government
1. Better quality diagnostic
services to the masses
2. Reduction in fixed costs
on diagnostic services
3. Better utilization of
resources

2 Benefit to Community
1. Increase accessibility to
improved quality of
diagnostic services at low
or free of cost

3 Benefit to Private Partner

1. Reduced business risk
2. A sizeable client base
3. Availability of ready
infrastructure
4. Lower initial investment

These lacunae in the system adversely effects the efficiency and operation of the hospital by,
1. Delaying the treatment procedure
2. Restricting the treatment capacity of the medical practitioners
3. Absence of proper diagnostics may lead to judgmental errors on the condition of the patients
4. Everyone is immune or counter reactive to certain drugs and chemicals, lack of diagnostic service
may adversely affect the treatment out comes
Feasibility Report for Setting up of Diagnostic Centre.
5. Inhibits the continuity of medical treatment
6. De-motivates the medical practitioners are they are not able to extend to their fullest capacity.
Market Feasibility

Demographic information

This comprehensive study included 100 participants (15 paramedics, 55

members of the public, 20 emergency medical practitioners and 10 technologists) with a diverse
knowledge background.

Chart Title

paramedics
15%
emergency medical prac-
titioners
55% 20%
technologists
10% members of the public
Approach & Methodology, studies, surveys including data collection, analysis

A primary research was carried out to,

Study and understand the operations of the selected district of the state and identify their needs of
ultrasound and CT scanner
Assess the availability of Diagnostic services for the district population with the public and private
facilities
Assess the business environment in terms of market dynamics, pricing competition, regulations
Discussions with key stakeholders in the location, to ascertain the market opportunities in the selected
regions and the expectations of clientele
A detailed sensitivity analysis on the base case projections with respect to the key drivers affecting
revenue, streams of business and capital cost.

Based on the detailed research and modeling, the ideal pricing structure for the diagnostic service has
been proposed.

Secondary research

We supplemented the primary survey with secondary research focused on similar this -models across
the country, operating models of diagnostic centres and pricing of services
Key Players in Diagnostic Market

In the primarily diagnostics segment, the top-four corporate players by sales include Metropolis, Dr
Lal Pathlab, Super Religare and Piramal Diagnostics (now a subsidiary of Super Religare). This
section profiles some of the large corporate diagnostic services providers in India.

Industry Feasibility
In India, majority (70-80 per cent) of medical treatments are based on laboratory diagnostic tests, thus
making it one of the most promising sectors in the healthcare industry. In India, the medical
diagnostics industry accounts for almost 10 per cent of the healthcare sector’s revenues. With the
growth in income and health insurance coverage, there is an increasing demand for better healthcare
services among the growing population of the country. The sector’s growth will be driven by the
country’s growing middle-class, which can afford quality
healthcare.

Healthcare diagnostics is growing at the rate of 15-20 per cent per annum. The major driver for this
growth is the wide gap of 70-80 per cent cost-advantage that Indian companies have over different
countries. Today, patients from neighboring countries in Asia are coming to India to receive
specialized medical treatment. India is now meeting international standards at a cost advantage
compared to developed countries.

In addition to this, the vast difference in costs between Western countries and India, the country is
being seen as the preferred destination for quality health solutions. This has been reflected by
increasing medical tourism.

The Indian diagnostic market is broadly divided into equipment and services. The service sector is
found to be largely unorganized, with a large presence of players located at the regional or city level.
However, a clear and structured format is being established to have better regulations and proper
definition for the market. The use of advanced and cutting-edge technologies in understanding a
disease prognosis has further strengthened the sophistication level of participants in the sector.
Organisational feasibility

For setting up of a district diagnostic centre in a district hospital the requirements are as follows,

a) Space for diagnostic service – 3000 sqft to 4000sqft of built up space for providing all the
necessary variety of test, sample collection, waste disposal, rest room, cleaning and store room
b) Requisite number of semi automatic, fully automatic and manual equipments as it needs for the
service mix
c) Sample collection set up
d) Patient waiting area
e) Computerisation, networking of equipments and installation of a Lab Management Information
System for integrating sample collection, test results recording, data base management and delivery of
results
f) Consumables and chemicals as required.
New Business Concept
ULTRASOUND AND CT SCANNER SERVICE IN AMBULANCE

SERVICE FEASIBILITY;
Ultrasound and CT Scanner service in ambulance and provide home medical services. The Ultrasound
and CT Scanner service is for emergencies patient for possible early diagnosis and to then send
patient data to the relevant hospital before arrival.
The Indian diagnostic market is broadly divided into equipment and services. The service sector is
found to be largely unorganized, with a large presence of players located at the regional or city level.
However, a clear and structured format is being established to have better regulations and proper
definition for the market. The use of advanced and cutting-edge technologies in understanding a
disease prognosis has further strengthened the sophistication level of participants in the sector.
Financial feasibility

It is proposed that the Diagnostic centre is provided on contract for a period of ten years, following
which it will be rebidded. The reasons for selecting 10 years as optimum concession period are
following;
1. Rapid Technological changes happening in the current era are making existing diagnostic
technology obsolete in 10 years. So better diagnostic tools will render current machines undesirable
and non operational in coming 10 years.
2. Of the total capital investment of 1.50 crores, around 90 percent is pertaining to the machinery.
.
Cost of Service

The service provider shall charge the government a fixed amount towards each test conducted, this
shall be an agreed fraction of the existing CGHS rates for diagnostic service delivery. The fractional
cost at which the partner agrees to provide the service shall be the bid variable during the process for
finalizing the service provider. The government shall revise the service cost as and when the CGHS
rates are revised, which is once in two years normally.
The partner is encouraged to set up the district laboratory as a hub and establish collection centres.
The tests not available in the any Hospital shall be done at the district hospital laboratory and results
delivered back at the respective hospital. This process shall ease the load at district hospital for want
of diagnostic service at lower hospitals.
The partner can service the patients referred by the private doctors also but at government rates.
Thus the service provider has two streams of revenues,
1. Reimbursement by the Government from tests referred from DH and other public hospitals (at a
fractional cost of prevailing CGHS rate)
2. Referral patients from private practitioners, who pay personally for the service delivered
Financial projections of the proposed project model

Modeling the financial projections of a diagnostic centre is complex because of the following reasons,
1. The service delivery mix varies from lab to lab, this influences the infrastructure, consumables,
capital and manpower used, which results in variation in pricing and providing services in ambulance.
2. The pricing depends on the cost of capital at each location
3. Different tests have different cost associated with them, it is difficult to project exactly the number
of tests that would be conducted and determine the price based on the same
4. The price is also dependant on the type and extent of equipment used for conducting the test; many
tests can be done in multiple ways each with an associated cost in ambulance
5. The price also depends on the quality of consumables used, for example vacutainer would
definitely cost more than using syringes, but vacutainer offer better sterility, easier and efficient
handling of sample, reduced contamination of sample and least discomfort to patient
6. If the laboratory is in equivalent certified it would increase the administrative cost of the
establishment, ultimately increasing the cost of service delivery
7. The cost of service delivery also depends on the operational process and turnaround time expected
from the service provider, while computerization and networking of equipment increases the
effectiveness and efficiency of the laboratory it also increases the cost of service delivery

Cost Estimation
Capital Infrastructure for Building & Equipment
The model assumes that the existing laboratory will be provided, or
the requisite space will be provided to the partner at free of cost in an
as is where is basis, the partner’s responsibility is to refurbish the
centre as per their work/process flow and NABL standards required.
The partner is also expected to put in place a Lab Management
Information System, which will integrate the processes and
equipment in the laboratory.

Investment
S. No CAPITAL PRODUCT {in CR}
BUDGET HEAD

1 Cost of ready -
building on 3000 sqft
area [@1500/sq ft]

2 Cost of Renovation 0.20

3 Cost of the Lab 1.10

equipment with 5
years of AMC

4 Cost of LIMS 0.20

5 Cost of Generator 0.04

Total Capital Cost (in crores) 1.54

Manpower cost
The model assumes the following manpower requirement for the District Diagnostic
Centre, Human Resource Requirements

S. No Position Person Monthly salary Total Salary /

Required annum (in
crores)*

1 Pathologist 2 120000 0.29

2 Lab 10 25000 0.30

Technicians

3 Lab Manager 1 27,000 0.03

4 Administrative 2 18,000 0.04

staff

5 Lab Attendants 5 18,000 0.11

& others

6 Sweeper 4 6,000 0.03

Total Capital Cost 0.80

* Salary also includes 20% 'Incentive for working in remote area'

In addition, the major role of ambulance in this project we use one driver as well as one
conductor which have some knowledge about the ultrasound treatment and CT Scanner
treatment. The most important is to provide one expert in that field.
Considering the above options, it is preferred to follow an established price standard to be
reimbursed on actual, but considering the facts that,

1. The firm is provided a constructed building which brings down the infrastructural cost
2. The government ensures captive patients for the partner
3. The firm is provided with additional government patients
4. The firm is allowed to serve private patients with following two riders
4.1. No discrimination in prices i.e. Price of diagnostic tests for private patients will be same as for
government patients but in case of ambulance we charge some amount for transportation i.e.
transportation cost
4.2. Priority shall be given to patients referred from government institutions. However, exception to
this can only be made in case of very sick / serious patient or an emergency situation the ambulance
are use at that time.
Environmental Impacts
The diagnostic procedure in ambulance does not produce harmful radiations or noise, but body fluid
wastes are generated during the procedure, which needs to be collected, stored, and disposed safely.
Stringent bio medical waste disposal processes need to be developed and implemented by the partner.

Social Impacts
Lab diagnostic service will be accessible to all the citizens irrespective of his/her region, urban/rural
location, gender, social and economic groupings. This will also bring equity in healthcare services
which also encompass disadvantaged groups (Scheduled Castles and Tribes) and vulnerable groups
(street children, elderly).
Other social impacts of this project are;
 The project will enable provision of high quality and high end diagnostic service for the public
which is currently unavailable at the district hospital {diagnostic ambulance service} and at the same
time is costly at private diagnostic centres.
 Improved efficiency of the government hospital due to availability of better diagnostic service
 Reduced referral to higher institutions for want to diagnostic service, thereby reducing the cost of
providing ambulance logistics facility
 Reduced referral from lower institutions for want of diagnostic service, thereby reducing
congestion
 The low cost, availability of the service will reduce the cost of service at a private centre
 Society will get the best of public and private services at one place i.e. private sectors quality and
efficiency at public rates thus reducing their economic cost of availing the healthcare services.
 Enhanced patient satisfaction and diminished strain
 Improved utilization of public healthcare facilities
 Timely diagnosis leads to better treatment and better medical results.
 This initiative will also help state government to achieve its goal of prevention of physical
disability by its early detection and intervention. This will bring major gains in terms of human well-
being, development and economic productivity.
 Patients will get access to high-end diagnostic imaging facility within the MCH premises saving
the travel time of going to another public health facility / private facility; this reduces the out of
pocket medical expenses. This way this project will help state government in mitigating the adverse
effect of escalating prices of diagnostics on state population.
 Employment generation for the trained manpower
 Streamlined operation and efficient work culture of private partner will impact the public
healthcare functioning in the long run
 Reduces the cost of diagnostic service at the private facility due to market competition effect
Mitigation Measures
Diagnostic equipment and process should be operated under strict trained manpower supervision, the
following safety measures need to be taken into account,
1. Diagnostic machines and associated equipment must be located and designed as per the
manufacturer’s specific layout guidelines
2. Machine should always be under CMC for regular maintenance
3. Proper sterilization and infection prevention practices should be adhered to
4. Quality of consumables should be maintained for consistency and efficiency of results
5. Proper BMW collection, storage and disposal norms should be developed and adhered to

Following are the perceived risks involved in developing a diagnostic centre

1. Construction / implementation risk arising from
a. Delay in project clearance
b. Contractor default
c. Construction cost overrun

2. Market risk arising from

a. Insufficient demand
b. Impractical user levies

3. Finance risk arising from

a. Inflation
b. Change in interest rates
c. Increase in taxes

4. Operation and maintenance risks arising from

a. Termination of contract
b. Technology risk
c. Manpower risk
5. Legal risks arising from
a. Changes in law
b. Changes in lease rights
Websites development;

Requirements imposed on best hospital websites

Here are a few key factors to be considered when creating a new website for a hospital:


The requirements imposed on the professional presentation of your content, its completeness, and
accuracy are increased. It’s quite natural, because the price of incorrect information is much higher in
the medical field, and therefore special attention should be paid to the issue.


On the other hand, the pages of medical websites should be clear to the average user of medical
services/products. As practice shows, a potential patient, as well as a purchaser of medical equipment
or medicines, is particularly demanding on the completeness, clearness,  and simplicity of data.


When creating a website design for the hospital, the cluster approach is of particular importance, in
other words - the formation of partnership relations aimed to promote healthcare goods and services.
This method allows us to provide a patient with a complete service of high quality.


We've defined all the necessary requirements… and now we have the next issue. What features should
we offer to please your online medical website visitors?

The features of the hospital website

To ensure that your online medical website brings you the maximum benefit, you need to provide the
best user experience by offering the intuitive interface and helpful functionality.
We advise you to consider the following hospital website features:


a detailed list of services and price list. This is the first thing a patient is usually trying to find: what
exactly you are offering and how much it costs.


booking an appointment with a doctor in the online mode;



online chat. The patient can communicate with the representatives of medical organizations and ask
questions, which interest him (it's another point of your hospital marketing strategy).


the emergency call. A very useful feature, which comes in handy when a patient needs to call in a
doctor urgently.


interactive map. Such a feature helps the patient find your hospital without any problem.


blog. Devote one section of your online medicine site to articles, which may potentially interest
patients. These articles can include useful medical tips, treatment programs, methods of diagnosis, and
other things in the same vein.


information about the doctors. Undoubtedly, your patients care about which specialist will treat
them. Help them to get the data they are interested in by giving all the details about each doctor: his
experience, qualifications, awards received. It’ll also be advisable to indicate a doctor's schedule and
provide a patient with a possibility to book an appointment with the expert immediately.


description of the hospital's departments.


 

3D tour over the hospital wards. The feature belongs to the expensive but noteworthy ones. It would
be a good addition to the hospital website design - patients would appreciate the chance to see your
clinic in the three-dimensional format (which can lead to a significant increase in the level of positive
user experience).


online doctor's advice. Of course, the doctor won’t be able to make a full diagnosis using the
services of your online medicine site but he can refer the patient to the right specialist or help in an
emergency situation.


feedback form. A patient should have the opportunity to get a feedback channel. It'd be also smart to
lead the "Question-Answer" forum. It’ll allow you to know the opinions and wishes of your patients
much better.


What to consider to build a medical web resource

Undoubtedly, if you’re a layman (a doctor or clinic manager), you’ll find the creation of a medical
web resource an impossible task. And if you're seriously considering hospital website development,
it’s worth finding competent web experts.
So, the optimal and effective solution means that you’re getting:
the skilled approach;
the skilled approach;
reasonable prices;
a convenient and clean website;
the perfect basis for the subsequent web promotion.

We recommend that you seek help from the medical web experts of our Agilie team. They’ll create
the best hospital website: effective, functional, and appealing (the one you expect!).
We can build a hospital web resource of any complexity. Order our services if you have a…

commercial or public clinic;

diagnostic center;
medical online store;
online pharmacy;
dental clinic;
cosmetology salon.
MOBILE APPSS
AI-Powered Healthcare Apps and Consumers
According to reports (Accenture), the number of healthcare consumers to embrace digital technology
is increasing every year.
 75% of US consumers that have been surveyed said technology is important to managing
their health
 Patients are open to smart technologies that can improve the self-care process
 Patients love self-service digital health tools that go beyond websites
 74% of the people who experienced a virtual health care service were very satisfied
 Nearly 50% of patients prefer an immediate, virtual appointment over an in-person visit
These high numbers have attracted many healthcare providers and future entrepreneurs to invest in
healthcare mobile apps.
If you’re a healthcare service provider or if your business belongs to the medical industry, then a
mobile healthcare app can be your most profitable investment.
CONCLUSION
Ultrasound and CT Scanner is a new and interesting opportunity for pre-hospital medical service. It
significantly improves the management of pre-hospital care and reduces the "door to diagnosis and
therapy time", which is one of the most important factors in improving medical assistance and
survival.

The first recommendation of pre-hospital ultrasound and CT Scanner is rapidity, if used correctly, it
will certainly improve the management of patients and precious time will be saved.

Therefore, the examination must be rapid, not more than 2-3 minutes. For example, pre-hospital
usually takes no more than 3 minutes. The identification of lung sliding, the diagnosis of
pneumothorax, and the evaluation of abdominal aorta usually lasts less than 1 minute. Heart studies
during cardiopulmonary resuscitation should be performed in 10 seconds during the rhythm check.
Alternatively, images and video clips can be recorded and analyzed later while RCP is ongoing.

Technical skills are the same or even simpler than in-hospital critical ultrasound. The exam should
answer specific yes/no questions, i.e., Is there a pneumothorax? Is there free fluid in the pleura,
pericardium, peritoneum? Is there an aortic aneurism? Are the lungs wet or dry?

The indications must be few and well-defined to combine effectiveness and speed. Trauma,
respiratory insufficiency, shock, cardiac arrest and severe abdominal pain, to rule in or rule out an
abdominal aortic aneurism, are situations where pre-hospital ultrasound makes the difference.

Pre-hospital ultrasound and CT Scanner still has some limitations. First, international guidelines and a
specific training are still lacking. There is no worldwide agreement on pre-hospital ultrasound yet.
Also, diagnostic capability is well known, but some doubts remain regarding the real impact on
outcome and survival. More over there isn't any relevant evidence regarding the cost-effectiveness of
pre-hospital ultrasound.