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use is different than that of in-hospital providers. In traditional single battalion during a deployment in 2009. In this study,
hospital settings, ultrasound often assists in difficult diagnostic 29 out of 40 Special Forces medics (18Ds) received ultrasound
pathways. For example, undifferentiated shock may be diffi- training, with a modal number of 8 hours. The specific details
cult to appropriately categorize as distributive, cardiogenic, of the training were not given; however, the authors noted that
obstructive, or hypovolemic. However, in the combat theater, trauma diagnostic ultrasonography exams and E-FAST exams
the etiology of shock is rarely a mystery. Furthermore, the im- comprised most of the training. As a part of the 18Ds’ ongoing
plications of ultrasound findings in the hospital setting often training, they conducted ultrasound exams during the deploy-
drastically change management, such as the extended focused ment to be reviewed later. Upon review, the authors found that
assessment with sonography in trauma (E-FAST), determin- out of the 109 exams performed 39 were classified as muscu-
ing the need for surgical intervention. However, in the tactical loskeletal (MSK), 34 as abdomen/trauma (E-FAST, covering
environment, advanced interventions, such as surgery, are not lung, cardiac, and abdominal exams), 22 as superficial, 8 as
immediately available, and the decision to not facilitate evac- special applications, 3 as procedural, and 3 as miscellaneous,
uation based on a negative ultrasound examination would be defined as not interpretable/unknown. Of note, superficial was
ill-advised. Given these differences between in-hospital and defined as abscess evaluation of a foreign body, and special
Special Operations medicine, it is worth evaluating the role of applications was defined as advanced application relevant to
PoCUS specifically in SOCM practice. SOF practice, including fetal viability, ocular foreign bodies,
retinal detachment, nephrolithiasis, and vascular studies.
Methods
The second general article was a literature review that cov-
To assess the current use of ultrasound in SOCM practice and ered articles describing PoCUS use by military clinicians, with
explore potential future applications, the author first con- sensitivity and specificity reported. In this review by Savell et
ducted a broad literature search specific to SOCMs. The au- al., 14 studies were included with 4 that included SOCMs.
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thor initially searched the PubMed database in September 2023 The authors concluded that the evidence describing military
for any articles describing SOCM use of ultrasound in clinical use of PoCUS is limited. They also concluded that the limited
practice. Upon completing this search, the author found no evidence available supports the theory that military clinicians
descriptions of SOCM-specific clinical ultrasound usage out- can perform various PoCUS examinations with adequate sen-
side of the Journal of Special Operations Medicine. Addition- sitivity and specificity, particularly FAST exams and fracture
ally, only a single article outside of this journal was identified, detection.
which described a potential future application of ultrasound
for SOCMs, specifically the ability of SOCM trainees to suc- Neurologic Articles
cessfully perform optic nerve sheath examinations on healthy In this review, a single article addressing the diagnostic appli-
volunteers. 8 cation of ultrasound for neurologic pathology was identified.
This article by Hightower et al., describes the pathophysi-
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Given the lack of literature outside of the Journal of Special ology and logistics related to detecting elevated intracranial
Operations Medicine, a focused search was conducted within pressure by measuring optic nerve sheath diameter. The au-
this journal. This search was conducted using the PubMed da- thors argue that employing ultrasound for this purpose could
tabase with the following keywords: ((FoCUS) OR (PoCUS) be beneficial in military field setting, especially for SOF medics
OR (Ultrasound) OR (Ultrasonography)) AND (Journal of who have received the necessary training.
Special Operations Medicine)). This search occurred on Oc-
tober 9, 2023, resulting in 120 initial search results. All 120 Additionally, the previously discussed article by Morgan et
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abstracts were reviewed by the author with articles describing al. references the procedural application of ultrasound in
the clinical use of ultrasound by SOCMs or advocating for the relation to neurologic structures. In this article, 3 of the 109
implementation of ultrasound among SOCMs being selected reviewed cases were of a procedural nature, with the authors
for inclusion and further review. The included articles were defining procedures as intravenous access or regional anesthe-
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then categorized by organ system, with distinctions made be- sia blocks. However, no additional details were provided re-
tween operational descriptions and advocacy of use, as well garding the specific types of regional blocks performed or the
as whether the described examination was procedural or di- circumstances surrounding their application.
agnostic in nature. The summarized findings are presented in
Table 1 and discussed in the following sections. Respiratory Articles
In this review, the author identified three articles supporting
the use of ultrasound by SOF medics for diagnosing respira-
Literature Review, Content
tory pathology, specifically pneumothoraces. The first article,
General Overview / Multiple Systems Articles an observational study by Monti et al., involved 22 non-
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Among the 20 articles included in this review there were 2 that physician military members, including physician assistants
presented a broad description of military and Special Opera- (without prior ultrasound training), SOCM and conventional
tions Forces (SOF) medicine ultrasound use across a variety medics, veterinary technicians, and food inspectors. The study
of organ systems. The first was a retrospective description of demonstrated that this diverse cohort was able to successfully
a Special Forces battalion’s use of ultrasound during a deploy- detect a pneumothorax in 44 hemithoraces using a pig model,
ment, and the second was a literature review covering military achieving high sensitivity and specificity after a brief train-
use of ultrasound, specifically in SOF medicine. ing presentation. The second article, an observational study
by Meadows et al., detailed 43 conventional medics examin-
The first general article was a retrospective observational ing 258 hemithoraces in a cadaver model and identifying the
study by Morgan et al. based on quality assurance data from presence of a pneumothorax with a high level of sensitivity
109 studies conducted by 29 Special Forces medics from a and specificity. The third article presented a clinical scenario
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28 | JSOM Volume 25, Edition 2 / Summer 2025