The Evolution of POCUS in Emergency Medicine: A Journey from Resistance to Revolution
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The Modern-Day Visual Stethoscope
In today’s emergency departments (EDs), a Point-of-Care Ultrasound (POCUS) machine is no longer a luxury—it is as essential as a stethoscope. Often referred to as the "visual stethoscope," ultrasound has become an indispensable tool in emergency medicine. Modern EDs are now equipped with multiple probes, making POCUS an integral part of primary surveys, procedural guidance, and critical decision-making. From vascular access and nerve blocks to joint aspirations and trauma assessment, ultrasound has become an inseparable companion in emergency care.
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However, the journey to integrating POCUS into emergency departments was not always smooth. It took years of advocacy, training, and persistence to overcome resistance and skepticism from hospital administrations. My own journey with POCUS began in 2007, and it has been a story of persistence, belief, and transformation.
The Beginning: My First Encounter with FAST
My first exposure to POCUS was in 2007, when I learned about the Focused Assessment with Sonography in Trauma (FAST) exam. To gain hands-on expertise, I underwent formal training in FAST ultrasound at Al Ain University, UAE. I was fortunate to be accompanied by esteemed colleagues—Dr. Babu Palatty, Dr. Sunitha, Dr. Tamorish, and Dr. Ashish Nandi—all of whom shared a common vision of bringing ultrasound into Indian emergency medicine practice.
This training was made possible by Dr. George Abraham, Chairman of IIEMS, who sponsored our participation. Dr. George was a visionary leader who played a pivotal role in the early days of Emergency Medicine (EM) development in India. His commitment to training and innovation laid the foundation for the integration of ultrasound into emergency care.
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| Dr George Abraham and Dr.Giji Abraham -A family contributed significantly in the inception of Emergency Medicine in India |
Upon returning to India, I was determined to incorporate FAST ultrasound into trauma protocols. At MIMS (now Aster MIMS), we had a portable ultrasound machine—Sonosite Micromaxx—which was shared between the ICU, anesthesia, and emergency department. However, accessing the machine was a bureaucratic challenge. The Managing Director (MD) controlled its usage, and a designated staff member held the key. Every time we needed the machine, we had to go through a lengthy approval process, making real-time emergency scans difficult.
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| POC machine, which was used in a common pool |
The Struggle for an Exclusive Emergency Ultrasound Machine
Recognizing the critical need for a dedicated POCUS machine in the ED, I proposed acquiring an exclusive ultrasound unit for the department. However, in 2010, this idea was met with strong resistance. The MD outright rejected the proposal, questioning how the hospital would recover the ₹18 lakh investment.
Determined to push forward, I restructured my proposal to demonstrate financial feasibility. I suggested:
- 60% of the cost could be covered from the MEM (Master of Emergency Medicine) program fees, which was already generating revenue.
- 40% could be funded by the hospital, ensuring minimal financial strain.
- Each ultrasound scan could be charged as low as ₹300, ensuring cost recovery within 2-3 years.
- As a personal assurance, I even offered to pledge my salary as a guarantee for the investment.
Despite this well-reasoned approach, the MD remained unconvinced, and the proposal stalled.
Breaking the Barriers: The Chairman’s Intervention
Realizing that a breakthrough was necessary, I escalated the proposal directly to the Chairman, Dr. Azad Moopen. During his next visit to Calicut, he convened a boardroom meeting to discuss the matter. The attendees included:
- Dr. Abdulla
- Prof. K.K. Varma
- Engineer Abdul Rahman
- Engineer Salahudhin
- CFO Jayakrishnan
- Other board members
The Chairman invited everyone to share their perspectives. I presented my case again, emphasizing the clinical and financial viability of having an exclusive POCUS machine in the ED. While the MD remained silent and the CFO stayed neutral, I persisted in making a strong case for its necessity.
Finally, the Chairman made a decisive statement:
“Abdulla, why don’t we give this machine to Dr. Venu? As an end-user, he is confident that it will be useful and successful. In that case, we must give them a quality machine with high-end features. We must give the M-Turbo from Sonosite.”
With this, the decision was made. The MD nodded in agreement, and the CFO approved the funding.
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| Sonosite -M Turbo |
A Landmark Achievement: India’s First Exclusive ED POCUS Machine
This historic decision led to MIMS Emergency Medicine Department receiving India’s first exclusive POCUS machine. The Sonosite M-Turbo became a game-changer, transforming emergency care at MIMS and setting a precedent for other hospitals across India.
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| First USG machine for the Emergency medicine department in MIMS Calicut Prof .Jeffry Smith ( Director International EM -GWU) launched it . Dr Abdulla Cherayakkatt nearby |
Today, we no longer struggle for ultrasound access. We now have the luxury of two ultrasound machines in our Calicut ED, and all rural emergency centers are also equipped with POCUS machines. What was once a dream and a battle for acceptance has now become a standard of care.
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| Magazine Color Doppler portrayed the story vividly |
The Future of POCUS in Emergency Medicine
Looking back, the journey from skepticism to widespread adoption has been inspiring. Today, POCUS is:
✅ An essential tool in emergency care
✅ Used for rapid diagnosis in trauma, cardiac arrest, and shock
✅ A standard for procedural guidance in vascular access, nerve blocks, and more
✅ A cost-effective investment with significant returns in patient outcomes
I am deeply grateful to Chairman Dr. Azad Moopen and the Board of Directors for their vision and trust in this initiative. Their support in those early days helped lay the foundation for modern emergency medicine in India.
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| Chairman Dr Azad Moopen |
As emergency medicine continues to evolve, POCUS will remain at the forefront, ensuring faster, safer, and more effective patient care. The visual stethoscope is here to stay, revolutionizing emergency medicine for generations to come.
Final Thoughts
This story is not just about acquiring a machine—it is about challenging resistance, pioneering change, and transforming emergency medicine. The journey of POCUS in Indian emergency departments is a testament to the power of perseverance, vision, and innovation.
To all aspiring emergency physicians, I say this: Never stop advocating for what improves patient care. The road may be difficult, but the impact is worth it.
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| In 2010, the MIMS emergency Medicine department conducted a 3-day workshop for ER doctors. Prof Keith Boniface (Emergency Ultrasound director - GWU) leading the hands-on session |
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| After a decade in 2020, an Exclusive USG machine in a rural emergency room at Malappuram. Ex minister and MLA Sri.P K Kunhali Kutty inaugurating |
