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A Simulator-Based Study of In-Flight Auscultation

Tourtier, Jean-Pierre MD; Libert, Nicolas MD; Clapson, Patrick MD; Dubourdieu, Stéphane MD; Jost, Daniel MD; Tazarourte, Karim MD; Astaud, Cécil-Emmanuel MD; Debien, Bruno MD; Auroy, Yves MD

doi: 10.1097/SIH.0b013e3182a833e0
Empirical Investigations

Introduction The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft.

Methods Sounds were mimicked using a mannequin-based simulator SimMan. Five practitioners examined the mannequin during a fly, with a variety of abnormalities as follows: crackles, wheezing, right and left lung silence, as well as systolic, diastolic, and Austin-Flint murmur. The comparison for diagnosis assessed (correct or wrong) between using the electronic and conventional stethoscopes were performed as a McNemar test.

Results A total of 70 evaluations were performed. For cardiac sounds, diagnosis was right in 0/15 and 4/15 auscultations, respectively, with conventional and electronic stethoscopes (McNemar test, P = 0.13). For lung sounds, right diagnosis was found with conventional stethoscope in 10/20 auscultations versus 18/20 with electronic stethoscope (P = 0.013).

Conclusions Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.

From the Emergency Medical Service (J.P.T., D.J., C.E.A.), Fire Brigade of Paris, 1 Place Jules Renard; Department of Intensive Care (N.L., P.C., S.D., B.D., Y.A.), Military Hospital Val-de-Grâce, Paris; Department of Intensive Care, Military Hospital Val-de-Grâce, Paris; Emergency Medical Service, Fire Brigade of Paris, 1 Place Jules Renard; Emergency Medical Service (K.T.), Melun, 11 Rue Freteau De Peny, Melun, France.

Reprints:Jean-Pierre Tourtier, MD, Pr Tourtier, HIA Val-de-Grâce, secrétariat de réanimation, 74 boulevard port royal, 75005 Paris, France (e-mail:

The authors declare no conflict of interest.

© 2014 by Lippincott Williams & Wilkins, Inc.