Procurement of ultrasound equipment that will function well and last for years in limited resource settings can be a challenge. When seeking ultrasound machines for use in a district hospital or health center, consider these features:

the manufacturer to provide in-service training to the regional site biomedi-

probes, a linear, high frequency probe can be quite useful for procedural guid-

Ultrasound services will only ourish if they address the immediate patient care needs of the clinicians and impact patient care substantially to offset time and human resources needed for training/implementation. To create this scenario, the program must include attention to the question of what happens when a surgical or medical emergency is diagnosed with ultrasound. Ultrasound programs are often most impactful when plans for rapid transfer to higher level of care, or to operative or transfusion services are arranged simultaneously or otherwise established. Therefore, we recommend beginning with a needs-assessment to discern which ultrasound applications will be most useful for each specic setting (Table 23.2: Needs Assessment sample questions) [17]. Once a needs-assessment has been per­formed, development and delivery of a tailored curriculum can begin.

rate coursework. Establish ability for image upload and distance learning options,

Despite good will and intentions, it can be a struggle to nd funding for develop­ment of ultrasound services in LMIC countries. Potential donated equipment should be thoroughly inspected before acceptance to ensure it is within the required speci­cations with respect to durability and functionality, and should always be deployed with a training plan in place which will likely require its own funding. Research in POC US use for specic indications in LMICs is an area rich for exploration [18]. Funded research studies can help to build local capacity both by engaging local providers in academic pursuits and by nancing general ultrasound training and equipment. The knowledge gained by local practitioners along with the ultrasound equipment remains long after the study period.

Providing sanitary medical care and ultrasound services can be a challenge in areas of the world where medical waste is burned or dumped near water supplies, and chemical agents such as Cidex and sterilization options are limited. For sanitation of probes, alcohol should be avoided, however diluted bleach solutions can be used for sanitation of most probes. Intracavitary probes consistently used with probe covers and bleach water and sterilized between uses should ideally not transmit disease. Nevertheless, local customs for sanitation of sensitive equipment should be followed [19, 20]. To encourage safe and responsible use of ultrasound, training should begin with the ALARA (as low as reasonably achievable) principle. Trainers should also be familiar with local ultrasound laws and regulations, including cultural and social issues, before embarking on ultrasound training missions. For example, teaching gender identication is illegal and punishable in areas of the world known for sex­selective abortion and female infanticide (e.g., China and India) [21, 22]. Archiving options are uncommon in LMICs, limited currently to PACS wireless upload and cumbersome mechanical downloading, however secure, cloud-based options are on the horizon. For example, Sonosite Inc. has partnered with Trice Imaging for Sonosite’s newly released iViz, which has embedded software to allow rapid, secure, cloud-based image transfer from remote locations using WiFi or cellular service.

• Highest impact of ultrasound is attained when POC US is paired with improve-

it involves ongoing partnership for training and education and a curriculum tai-