Current Practices in Prehospital Ultrasound: A Systematic Evaluation of Prehospital Protocols Within the United States.
Prehospital emergency care · 2025-10-30 · Systematic review
Abstract
OBJECTIVES: National guidelines highlight the benefit of prehospital ultrasound (PHUS) in patient care and identify it as a priority for research. Few studies presently exist that identify the current uses of PHUS. We aimed to evaluate the frequency and current utilization of PHUS within the United States (U.S.). METHODS: A structured review was conducted of emergency medical services (EMS) protocols from the United States listed in the Acid Remap website, the largest publicly accessible online database for EMS protocols for individual agencies and defined regions in the country. All listed protocols were eligible for inclusion. The EMS protocols were reviewed and those containing PHUS were included. Protocols were excluded if they were not related to prehospital care, duplicates, password protected, or if the protocol document could not be located. Additionally, if PHUS was listed solely as within EMS clinician scope of practice, but no specific use case was defined, the protocol was excluded. Included EMS Protocols were then reviewed to collect PHUS indication for use, type of scan, and minimum approved level of performing clinician. Descriptive statistics were reported. RESULTS: Of 657 EMS protocols, 514 protocols (78.2%) were reviewed. We excluded 143 (21.7%) protocols; the majority of these could not be accessed or located (n = 128/143, 89.5%). Ninety (17.5%) of the 514 protocols contained PHUS and it was most frequently intended for use by paramedics (n = 52, 57.8%). Prehospital ultrasound was most often contained in cardiac arrest treatment protocols (n = 68, 75.6%) and used to evaluate cardiac activity (n = 59/68, 86.8%). The next three most common protocols which contained PHUS included trauma (n = 51, 56.7%) with the extended focused assessment with sonography in trauma (EFAST) exam (n = 39/51, 76.5%), procedural guidance (n = 33, 36.7%) with peripheral access (n = 23/33, 69.7%), and dyspnea (n = 33, 36.7%) with B-Line assessment (n = 24/33, 72.7%). CONCLUSIONS: In the largest EMS protocol repository within the U.S., 17.5% of EMS protocols contained PHUS and use indications. The most frequently described indication for use was in cardiac arrest, followed by trauma, procedural guidance, and dyspnea. The most common scanning types of scans include evaluation of cardiac activity, EFAST, peripheral access, and B-Line assessment.