Page 29 - JSOM Summer 2025

Ultrasound Use by Special Operations Combat Medics

A Narrative Review Limited to the JSOM

Jonathan Curley, MD

ABSTRACT
Background: Ultrasonography has seen increasing integration as central venous access and thoracentesis. Furthermore, this
4
into the clinical practice of Special Operations Combat Medics policy statement acknowledges the increasing evidence sup-
(SOCMs). However, there is limited literature available that porting the use of ultrasonography in pre-hospital, military,
describes SOCM use of ultrasonography. This narrative review and tactical environments. Among these settings, the military
aims to provide an overview of how SOCMs use ultrasound and tactical environment implementation of ultrasonography
in clinical practice and explore proposed future applications. may have the most significant impact, given the potential lim-
Methods: A PubMed search was conducted for articles dis- itations on timely evacuation and the necessity for possible
cussing ultrasonography in the context of Special Operations prolonged field resuscitation. These concerns are particularly
medicine. This search initially included a broad PubMed search relevant to Special Operations Combat Medics (SOCMs) be-
followed by a targeted search limited to the Journal of Special cause the unique operational mission requirements they face
Operations Medicine. Inclusion criteria for this targeted search often involve providing advanced treatment and precise diag-
encompassed articles describing ultrasound use or advocating noses while caring for patients and colleagues over extended
for ultrasound use in SOCM clinical practice. Results: The periods.
search was conducted in October 2023 and yielded 120 publi-
cations, of which 20 met inclusion criteria and are summarized Despite the demonstrated benefits of PoCUS in medicine, its
in this review. Among these articles, 50% focused on cardio- widespread adoption and use have been slower in some fields
vascular applications, 35% on musculoskeletal applications, and settings. For instance, in anesthesiology, the adoption of
20% on abdominal assessments (E-FAST exam), 15% on re- PoCUS for diagnostic purposes has lagged behind fields like
spiratory applications, and 10% on neurologic applications. emergency medicine and critical care medicine, with a lack of
Only 40% of the articles described operational use, while 60% ultrasound equipment often cited as a reason. A study of ru-
5
advocated for use. Finally, 56.5% of the articles described di- ral emergency departments in the United States and Canada
agnostic applications, while 43.5% pertained to procedural found that a shortage of equipment and training contributed
applications. Conclusion: SOCM use of ultrasonography likely to the slow adoption of ultrasound in these environments.
6
differs from in-hospital provider use of ultrasonography. To im- These barriers in training and equipment can now be over-
prove ultrasound education for SOCMs, educators should con- come with the current availability of portable, handheld ul-
sider customization of the curriculum to align with the unique trasound devices. These devices are cost effective compared to
mission requirements of individual units and an increased em- traditional cart-based hospital ultrasound equipment, allowing
phasis on procedure-based training. systems or units to acquire multiple devices, thereby providing
increased access to ultrasound technology. Furthermore, many
Keywords: ultrasound; PoCUS; FoCUS; military medicine; of these devices offer telemedicine capabilities, enabling per-
Special Operations Medicine forming practitioners to receive real-time guidance on image
acquisition and interpretation. The availability of small, porta-
ble, lightweight, inexpensive ultrasound devices that offer the
Introduction ability to receive telemedicine guidance makes this technology
not only more accessible to in-hospital medical specialties but
Point-of-care ultrasonography (PoCUS) has become an inte- also to the SOCM community. Consequently, the use of ultra-
gral and widely used tool in medicine, especially in acute set- sound has been included in the scope of practice of SOCMs as
tings. The American Society of Echocardiography recommends demonstrated by the creation of the Special Operators Clinical
the use of focused cardiac ultrasonography (FoCUS) to guide Level Ultrasound (SOLCUS) course. 7
clinical management in cases of shock or hemodynamic insta-
bility, with a grade I recommendation. The Society of Critical Despite PoCUS being implemented in the scope of practice
1
Care Medicine also advocates for PoCUS in the evaluation of of SOCMs, its impact and usage is not well-documented in
undifferentiated shock, chest trauma, and pneumothorax, as available medical literature. For instance, the use patterns and
well as for procedural guidance in numerous critical care pro- attitudes toward the utility of ultrasound in SOCM clinical
cedures. The American College of Emergency Medicine has practice among individual medics or among different units are
2,3
issued a policy statement endorsing the use of PoCUS for a not well described. An improved understanding of current and
wide range of clinical applications, including diagnostic assess- proposed future SOCM PoCUS practices would be beneficial,
ments and the safe performance of various procedures, such as it is possible that the value SOCMs receive from ultrasound
Correspondence to Yzs6yf@uvahealth.org
Dr. Jonathan Curley is affiliated with the Department of Anesthesiology and Critical Care Medicine, University of Virginia, Charlottesville, VA.

27
27