Guide to RCEM level one ultrasound sign off



This is a quick guide for UK emergency medicine trainees that I wrote last year as was answering a lot of questions about how to get signed off for ultrasound skills as a trainee.

Level one is the sign off deemed as the basics needed to work at as an emergency department registrar or consultant in the UK as set out by the royal college of emergency Medicine.

This involves


To be signed off as “level one competent” you need the following

  • To attend an approved level one course
  • To have a 10 observed scans of eFAST, Aorta and Echo in life support in your logbook
  • 5 observed Ultrasound guided cannulation
  • Once this is complete you have to have each of these exams observed by the regional ultrasound training lead. This is a competency sign off, so have to have the required level of skill to be deemed to be let lose to ultrasound independently.

Tip and tricks

The observer for your scans has to be a level one practitioner who has been signed off for more than a year; most newer consultants will be able to do this.

ECHO is the can most people have difficultly with. This is a technically difficult procedure and requires considerable practice (a lot more than 10 in my opinion). However the level of detail needed for a “echo in life support” is considerable below that of a cardiology/intensive care ECHO. It has to answer three questions only.

1/ Is there an effusion

2/Is the heart beating

3/Is there effective cardiac contractilty.


Level 2 sign off is currently slightly in flux with the new set up yet to be concerned. For those keen on further qualifications FICE (for critical care type US) or FEEL run by the resus council are two options. 

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