World Journal of Surgery

, Volume 38, Issue 5, pp 1009–1018 | Cite as

Focused Assessment Sonography for Trauma (FAST) Training: A Systematic Review

  • Alshafi Mohammad
  • Ashraf F. Hefny
  • Fikri M. Abu-Zidan



The aim of this study was to systematically review the different methods for training Focused Assessment Sonography for Trauma (FAST), course design, and requirements for hospital credentialing.


We searched MEDLINE/PubMed, EMBASE, and the Cochrane database and performed a manual search of selected papers. All papers and abstracts written in English that studied training and education of FAST were included. Papers were critically evaluated, looking into training methods and models of FAST, their advantages and disadvantages, number and type of training hours, practice exams in the course, and number of cases advised to achieve hospital credentialing.


A total of 52 studies were critically analyzed. The theoretical part of the courses lasted over a median (range) of 4 (1–16) h (n = 35 studies), while the practical part lasted over a median (range) of 4 (1–32) h (n = 34 studies). The participants performed a median (range) of 10 (3–20) FAST exams during the courses (n = 13 studies). The most commonly used model was the normal human model (65 %), followed by peritoneal dialysis patients (27 %). The least used models were animal (4 %) and cadaveric models (2 %). Each of these models had their advantages and disadvantages. The median number (range) of FAST exams needed for credentialing was 50 (10–200) (n = 19 studies).


Standardization of FAST training is important to improving the clinical impact of FAST. Different models used in FAST training are complementary; each has its own advantages and disadvantages. It is recommended that FAST courses be at least 2 days (16 h) long. The first day should include 4 h of theory and 4 h of training on normal human models. The second day should enforce learning using animal models, case scenarios including video clips, or simulators.


Peritoneal Dialysis Peritoneal Dialysis Patient Practice Exam Accept Failure Rate Hospital Credentialing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Rozycki GS, Ochsner MG, Jaffin JH, Champion HR (1993) Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma 34:516–526PubMedCrossRefGoogle Scholar
  2. 2.
    Abu-Zidan FM, Zayat I, Sheikh M, Mousa I, Behbehani A (1996) Role of ultrasonography in blunt abdominal trauma: a prospective study. Eur J Surg 162:361–365PubMedGoogle Scholar
  3. 3.
    Shackford SR, Rogers FB, Osler TM, Trabulsy ME, Clauss DW, Vane DW (1999) Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma 46:553–562PubMedCrossRefGoogle Scholar
  4. 4.
    Radwan MM, Abu-Zidan FM (2006) Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon’s perspective. Afr Health Sci 6:187–190PubMedCentralPubMedGoogle Scholar
  5. 5.
    Gracias VH, Frankel HL, Gupta R, Malcynski J, Gandhi R, Collazzo L, Nisenbaum H, Schwab CW (2001) Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing. Am Surg 67:364–368PubMedGoogle Scholar
  6. 6.
    Kim DY, Yelle JD, Lee AC, Woo MY (2009) National survey of Canadian general surgery program directors regarding focused assessment with sonography for trauma. J Surg Educ 66:193–195PubMedCrossRefGoogle Scholar
  7. 7.
    Gogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P (2010) Is basic emergency ultrasound training feasible as part of standard undergraduate medical education? J Surg Educ 67:152–156PubMedCrossRefGoogle Scholar
  8. 8.
    Freitas ML, Frangos SG, Frankel HL (2006) The status of ultrasonography training and use in general surgery residency programs. J Am Coll Surg 202:453–458PubMedCrossRefGoogle Scholar
  9. 9.
    Bowra J, Forrest-Horder S, Caldwell E, Cox M, D’Amours SK (2010) Validation of nurse-performed FAST ultrasound. Injury 41:484–487PubMedCrossRefGoogle Scholar
  10. 10.
    Unlüer EE, Yavaşi O, Kara PH, Kılıç TY, Vandenberk N, Kayayurt K, Kıyançiçek S, Akoğlu H, Yılmaz C (2011) Paramedic-performed Focused Assessment with Sonography in Trauma (FAST) in the emergency department. Ulus Travma Acil Cerrahi Derg 17:113–116PubMedCrossRefGoogle Scholar
  11. 11.
    Abu-Zidan FM, Freeman P, Mandavia D (1999) The first Australian workshop on bedside ultrasound in the Emergency Department. N Z Med J 112:322–324PubMedGoogle Scholar
  12. 12.
    Abu-Zidan FM, Dittrich K, Czechowski JJ, Kazzam EE (2005) Establishment of a course for Focused Assessment Sonography for Trauma. Saudi Med J 26:806–811PubMedGoogle Scholar
  13. 13.
    Freeman P (1999) Ultrasound assessment of the trauma patient. Aust N Z J Surg 69:592–593PubMedCrossRefGoogle Scholar
  14. 14.
    Salen PN, Melanson SW, Heller MB (2000) The focused abdominal sonography for trauma (FAST) examination: considerations and recommendations for training physicians in the use of a new clinical tool. Acad Emerg Med 7:162–168PubMedCrossRefGoogle Scholar
  15. 15.
    Abu-Zidan FM, Hefny AF, Corr P (2011) Clinical ultrasound physics. J Emerg Trauma Shock 4:501–503PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Jang T, Kryder G, Sineff S, Naunheim R, Aubin C, Kaji AH (2012) The technical errors of physicians learning to perform focused assessment with sonography in trauma. Acad Emerg Med 19:98–101PubMedCrossRefGoogle Scholar
  17. 17.
    Bahner D, Blaivas M, Cohen HL, Fox JC, Hoffenberg S, Kendall J, Langer J, McGahan JP, Sierzenski P, Tayal VS (2008) American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of the focused assessment with sonography for trauma (FAST) examination. J Ultrasound Med 27:313–318PubMedGoogle Scholar
  18. 18.
    Salen P, O’Connor R, Passarello B, Pancu D, Melanson S, Arcona S, Heller M (2001) Fast education: a comparison of teaching models for trauma sonography. J Emerg Med 20:421–425PubMedCrossRefGoogle Scholar
  19. 19.
    Knudson MM, Sisley AC (2000) Training residents using simulation technology: experience with ultrasound for trauma. J Trauma 48:659–665PubMedCrossRefGoogle Scholar
  20. 20.
    Damewood S, Jeanmonod D, Cadigan B (2011) Comparison of a multimedia simulator to a human model for teaching FAST exam image interpretation and image acquisition. Acad Emerg Med 18:413–419PubMedCrossRefGoogle Scholar
  21. 21.
    Ali J, Rozycki GS, Campbell JP, Boulanger BR, Waddell JP, Gana TJ (1996) Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid. J Surg Res 63:275–279PubMedCrossRefGoogle Scholar
  22. 22.
    Ma OJ, Gaddis G, Norvell JG, Subramanian S (2008) How fast is the focused assessment with sonography for trauma examination learning curve? Emerg Med Australas 20:32–37PubMedCrossRefGoogle Scholar
  23. 23.
    Han DC, Rozycki GS, Schmidt JA, Feliciano DV (1996) Ultrasound training during ATLS: an early start for surgical interns. J Trauma 41:208–213PubMedCrossRefGoogle Scholar
  24. 24.
    Ali J, Campbell JP, Gana T, Burns PN, Ochsner MG Jr (1998) Swine and dynamic ultrasound models for trauma ultrasound testing of surgical residents. J Surg Res 76:17–21PubMedCrossRefGoogle Scholar
  25. 25.
    Wei G, Geria RN, McCoy JV, Church AF, Kapitanyan R, Ohman Strickland PA, Wormann D, Eisenstein RM, Riggs RL (2012) A novel approach to emergency medicine ultrasonographic education during medical student clerkships and its impact on testing: a pilot program. Ann Emerg Med 60(5):S187CrossRefGoogle Scholar
  26. 26.
    Abu-Zidan FM, Siösteen AK, Wang J, Al-Ayoubi F, Lennquist S (2004) Establishment of a teaching animal model for sonographic diagnosis of trauma. J Trauma 56:99–104PubMedCrossRefGoogle Scholar
  27. 27.
    Gracias VH, Frankel H, Gupta R, Reilly PM, Gracias F, Klein W, Nisenbaum H, Schwab CW (2002) The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination. Am Surg 68:1008–1011PubMedGoogle Scholar
  28. 28.
    Frezza EE, Solis RL, Silich RJ, Spence RK, Martin M (1999) Competency-based instruction to improve the surgical resident technique and accuracy of the trauma ultrasound. Am Surg 65:884–888PubMedGoogle Scholar
  29. 29.
    Kaufmann C, Liu A (2001) Trauma training: virtual reality applications. Stud Health Technol Inform 81:236–241PubMedGoogle Scholar
  30. 30.
    Platz E, Goldflam K, Mennicke M, Parisini E, Christ M, Hohenstein C (2010) Comparison of Web- versus classroom-based basic ultrasonographic and EFAST training in 2 European hospitals. Ann Emerg Med 56:660–667PubMedCrossRefGoogle Scholar
  31. 31.
    Platz E, Liteplo A, Hurwitz S, Hwang J (2011) Are live instructors replaceable? Computer vs. classroom lectures for EFAST training. J Emerg Med 40:534–538PubMedCrossRefGoogle Scholar
  32. 32.
    Pageau P, Woo MY, Stiell TG, Tashkandi M, Spacek A, Frank JR (2012) A controlled trial of traditional versus Web-based teaching of point-of-care ultrasound to medical students. Can J Emerg Med 14(Suppl 1):S26Google Scholar
  33. 33.
    Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H (1999) Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma 46:466–472PubMedCrossRefGoogle Scholar
  34. 34.
    Dubois L, Leslie K, Parry N (2010) FACTS survey: focused assessment with sonography in trauma use among Canadian residents training in general surgery. J Trauma 69:765–769PubMedCrossRefGoogle Scholar
  35. 35.
    McCarter FD, Luchette FA, Molloy M, Hurst JM, Davis K Jr, Johannigman JA, Frame SB, Fischer JE (2000) Institutional and individual learning curves for focused abdominal ultrasound for trauma: cumulative sum analysis. Ann Surg 231:689–700PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Förster R, Pillasch J, Zielke A, Malewski U, Rothmund M (1993) Ultrasonography in blunt abdominal trauma: influence of the investigators’ experience. J Trauma 34:264–269PubMedCrossRefGoogle Scholar
  37. 37.
    Ma OJ, Gaddis G, Steele MT, Cowan D, Kaltenbronn K (2005) Prospective analysis of the effect of physician experience with the FAST examination in reducing the use of CT scans. Emerg Med Australas 17:24–30PubMedCrossRefGoogle Scholar
  38. 38.
    Vassiliadis J, Edwards R, Larcos G, Hitos K (2003) Focused assessment with sonography for trauma patients by clinicians: initial experience and results. Emerg Med (Fremantle) 15:42–48CrossRefGoogle Scholar
  39. 39.
    Jang T, Naunheim R, Sineff S, Aubin C (2007) Operator confidence correlates with more accurate abdominal ultrasounds by emergency medicine residents. J Emerg Med 33:175–179PubMedCrossRefGoogle Scholar
  40. 40.
    Weerasinghe S, Mirghani H, Revel A, Abu-Zidan FM (2006) Cumulative sum (CUSUM) analysis in the assessment of trainee competence in fetal biometry measurement. Ultrasound Obstet Gynecol 28:199–203PubMedCrossRefGoogle Scholar
  41. 41.
    Leandro G (2005) Bias in meta-analytical research. In: Leandro G (ed) Meta-analysis in medical research: the handbook for understanding and practice of meta-analysis. Blackwell Publishing, BMJ Books, Oxford, pp 15–21CrossRefGoogle Scholar
  42. 42.
    Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC (2013) How to write a systematic review. Am J Sports Med. doi: 10.1177/0363546513497567 Google Scholar
  43. 43.
    Sisley AC, Rozycki GS, Ballard RB, Namias N, Salomone JP, Feliciano DV (1998) Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma 44:291–296PubMedCrossRefGoogle Scholar
  44. 44.
    Röhrig S, Seibel A, Zechner PM et al (2011) Thoracoabdominal sonography (E-FAST plus)—AI training module 5 in anaesthesiologist: performed focussed sonography. Anasthesiol Intensivmed Notfallmed Schmerzther 46:772–781PubMedCrossRefGoogle Scholar
  45. 45.
    Perera P, Mailhot T, Riley D, Mandavia D (2010) The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill. Emerg Med Clin North Am 28:29–56PubMedCrossRefGoogle Scholar
  46. 46.
    Mazur SM, Pearce A, Alfred S, Goudie A, Sharley P (2008) The F.A.S.T.E.R. trial. Focused assessment by sonography in trauma during emergency retrieval: a feasibility study. Injury 39:512–518PubMedCrossRefGoogle Scholar
  47. 47.
    Stawicki SP, Howard JM, Pryor JP, Bahner DP, Whitmill ML, Dean AJ (2010) Portable ultrasonography in mass casualty incidents: the CAVEAT examination. World J Orthop 1:10–19PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Neri L, Storti E, Lichtenstein D (2007) Toward an ultrasound curriculum for critical care medicine. Crit Care Med 35(5 Suppl):S290–S304PubMedCrossRefGoogle Scholar
  49. 49.
    Smith RS, Kern SJ, Fry WR, Helmer SD (1998) Institutional learning curve of surgeon-performed trauma ultrasound. Arch Surg 133:530–535PubMedCrossRefGoogle Scholar
  50. 50.
    Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD (1998) Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 228:557–567PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Thomas B, Falcone RE, Vasquez D, Santanello S, Townsend M, Hockenberry S, Innes J, Wanamaker S (1997) Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve. J Trauma 42:384–388PubMedCrossRefGoogle Scholar
  52. 52.
    Kirkpatrick AW, Hamilton DR, Nicolaou S, Sargsyan AE, Campbell MR, Feiveson A, Dulchavsky SA, Melton S, Beck G, Dawson DL (2003) Focused Assessment with Sonography for Trauma in weightlessness: a feasibility study. J Am Coll Surg 196:833–844PubMedCrossRefGoogle Scholar
  53. 53.
    Markowitz JE, Hwang JQ, Moore CL (2011) Development and validation of a web-based assessment tool for the extended focused assessment with sonography in trauma examination. J Ultrasound Med 30:371–375PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Alshafi Mohammad
    • 1
  • Ashraf F. Hefny
    • 1
  • Fikri M. Abu-Zidan
    • 1
  1. 1.Trauma Group, Department of Surgery, College of Medicine and Health SciencesUAE UniversityAl AinUnited Arab Emirates

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