Yeah, even shooting good x-ray films is hard (rather, you can probably learn the absolute basics of radiation exposure, etc fairly quickly, but there is enough art to it that a good tech does a much better job than a radiologist (usually) or a bad tech, just at very practical things like patient positioning. At least in my experience -- the other issue being the craziness of an entire trauma team plus potentially a patient's unit representative plus techs plus radiologist all in a small CT room, or in the case of enemy combatants, armed MPs plus sometimes "other" guys plus patient plus techs...

But ETT and a few other things are the low hanging fruit. And with teleradiology you can even skip the "verify you got a decent image" step, particularly intra-hospital or for small images, because the rad can look at it immediately and tell you if you should reshoot.

I'd almost bet you could take a zero-training nurse or paramedic and give him a telerad-enabled x-ray or CT and get acceptable results working interactively with a radiologist and/or real rad tech remotely. Ultrasound might be trickier, but I saw midwives (who couldn't read or write, although they were really smart otherwise) trained in 3 days. I've never actually seen an MR used in person (since metal fragments tend to not go well with them; they just magically appeared on the PACS from elsewhere), but I imagine the basics of operating the machine aren't too much more difficult than a CT.

Ultrasound is actually gaining a lot of ground in field EMS (especially in flight).

It has three primary uses: -FAST exams in trauma -IV access -Assessing for cardiac tamponade and guiding pericardiocentesis

This is what I do now, I used to do CT and X-ray. MRI and CT have very little in common. While the images, very broadly speaking, look similar, the background knowledge required is very different. And they have crap interfaces. Really bad one. I save the error messages that are funniest now. MRI scanners are unreliable, temperamental, hard to get consistent results from and require constant care to avoid screwing things up! MRI isn't very good with serious trauma - too slow. I do miss that work though.

Yes to you and RDL - I see the point. I do dispute the 5-10 minutes though, but the point was that it could be learnt relatively fast. I'd assume some sort of weight versus exposure factors chart would hold 80% of the knowledge and when combined with a set 180cm tube-film distance and a digital system (forgiving!), things would be learnt quite fast. It is deceptive how hard it is to get a patient properly straight, and thereby prevent ET looking deviated.

You could probably combine a CCD/CMOS imager (i.e. cheap webcam) with an x-ray (and maybe mm-wave imager or something) to help with this. Something like an AED as applied to radiology, with safety interlocks.

It would definitely be possible to have very simple scans done by someone who was given a crash course training (knees, lumbar spines, brains). The problem is that the most complicated work always fails to advertise itself - I found a liver tumour yesterday while scanning a lumbar spine. It appeared on 1 image of the planning scan (a crap, low res image). The student was was present didn't see it and dismissed it as an artifact when I pointed it out, and she is a good student. I'm sure protocols could be made to avoid problems (send all imaging to the PACS, even the duds) like this however.

One advantage is that you have a very fixed environment in the back of an ambulance. The stretcher is going to be in exactly the same place every time (I'd assume you'd have some sort of 'slot' to drop the 'film' in on the underside of the stretcher), and there are all sorts of fixed reference points in the back of the truck.

Patient positioning is something that we're pretty good at to begin with (if you think it's a pain to get them lined up to shoot the ET... try lining them up to drop it in the first place...)

The bit where they are fighting you off is the bit I always watched with interest. The erect or supine images are sort of scripted in ones mind after a while. It's the semi erect child with ankylosing spondylitis or some such thing that cause distraction. I remember the situation like it was yesterday. It must have been 10 years ago. I never did manage to get a film where the poor guys knee caps didn't appear over the bases of his lungs on every attempt. We never did see his lung fields well.