Page 32 - JSOM Summer 2025

educational prompt (fictional training case description) dis- FAST exams and fracture detection, with acceptable sensitiv-
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cussing and advocating for the use of ultrasound imaging of ity and specificity.” Lastly, the case report by McLeroy et al.
the lung to assess for pleural sliding to rule out a pneumotho- described a clinical scenario in which a SOCM employed an
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rax. All these articles endorse the use of ultrasound among E-FAST examination following a knife wound sustained by a
SOCMs to assess for the presence of a pneumothorax. The 5-year-old foreign national child.
author did not find any descriptions of procedural use of ul-
trasound in relation to the respiratory system. Musculoskeletal Articles
In this review, the author identified five articles that discussed
Cardiovascular Articles the use of ultrasound for MSK assessment purposes. Notably,
The author identified a single article describing the diagnostic there was a prospective study by Heiner et al. involving 20
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use of ultrasound in relation to the cardiovascular system. The U.S. 18Ds who evaluated the presence or absence of fractures
article is a case report by McLeroy et al. describing the clinical in five models made using turkey legs surrounded by a gel-
scenario surrounding a 5-year-old host nation child who sus- atin solution. The result of the study revealed that the 18Ds
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tained an injury from a small, 5cm knife. During the initial achieved 100% sensitivity and 90% specificity. Additionally,
assessment in this case, an SOF medic conducted an E-FAST the author identified four case reports that described ultra-
examination, revealing a possible pericardial effusion. Subse- sound assessments related to various MSK issues, including
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quent radiographic imaging suggested pneumopericardium as pectoralis major muscle tears, pelvic fracture diagnosis and
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well as pneumoperitoneum with concern for left diaphragm ultrasound guided reduction, operational diagnosis of a long
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rupture. bone fracture, and diagnosis of rib fractures. 28
In contrast, the author found eight articles advocating for and Literature Review, Descriptive Results
detailing the procedural use of ultrasound among SOF medics In this review, the majority of the 20 articles included described
for hemorrhage control, along with a single article that noted ultrasound applications in relation to the cardiovascular sys-
ultrasound use for intravenous access. Most of the articles on tem (50%), followed by the following systems: MSK (35%),
hemorrhage control focused on resuscitative endovascular bal- abdominal (20%), respiratory (15%), and neurologic (10%).
loon occlusion of the aorta (REBOA). For reference, REBOA Among these articles, the majority (60%) advocated for the
involves arterial access followed by the placement of an inflat- use of ultrasound in relation to their respective organ system,
able balloon device to occlude distal blood flow and control rather than describing operational usage (40%). The propor-
bleeding. Four articles demonstrated that non-surgeon provid- tion of diagnostic and procedural exam articles was similar
ers could successfully place REBOA devices in a simulation set- at 56.5% and 43.5%, respectively. When assessed by organ
ting with minimal training and advocated for the consideration system, the proportion of articles describing diagnostic versus
of REBOA in combat operational environments. 16–19 Another procedural use of ultrasound was as follows: neurologic, 50%
article described the ability of emergency medicine physicians diagnostic and 50% procedural; respiratory, 100% diagnostic;
to identify the location of previously placed REBOA devices in cardiovascular, 10% diagnostic and 90% procedural; abdom-
a cadaver model using ultrasound assessment, again advocat- inal, 100% diagnostic; and MSK, 100% diagnostic and 14%
ing for the ability to place and position REBOA devices in the procedural (1 article both diagnostic and procedural). These
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austere environment using ultrasound. A single case series descriptive results are summarized in Table 2; note that some
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by Manley et al. was identified, which described four cases totals exceed 100% due to some articles being categorized as
in which a forward operating surgical team used a handheld both diagnostic and procedural.
ultrasound device to diagnose hemoperitoneum and place and
position REBOA devices leading to stabilization of these pa- Discussion
tients until surgical intervention could be achieved. Addition-
ally, two articles included in this review referenced ultrasound The most relevant of the articles reviewed above is the article
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as the gold standard for ensuring hemorrhage control, with by Morgan et al. It is distinguished from the others as it pro-
one assessing tourniquet effectiveness using Doppler, and the vides a detailed account of how SOCMs used ultrasound over
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other, ultrasound to detect adequate compression to control an extended period. This retrospective observational study
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bleeding. Finally, in the previously discussed article by Mor- yielded several noteworthy findings.
gan et al., 3 out of the 109 reviewed cases were procedural in
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nature with the procedural category including obtaining intra- First, it was evident that ultrasound was not commonly used
venous access. among SOCMs. In this study, 29 18Ds conducted only 109
ultrasound examinations over an entire deployment, although
Abdominal Articles the actual duration of the deployment was not specified. While
In conducting this review, the author did not identify any arti- this lack of ultrasound integration into routine clinical prac-
cles specifically dedicated to describing procedural or diagnos- tice is notable, any attempt to explain this finding would be
tic abdominal ultrasound examinations. However, several of speculative and warrants further investigation and research.
the previously discussed articles referenced the E-FAST exam-
ination, in addition to the topics previously covered. Morgan Second, when SOCMs did employ ultrasound, they demon-
et al. reported that 34 out of the 109 reviewed cases were strated adaptability by extending its use beyond their initial
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categorized as “abdomen/trauma,” a classification defined by training to meet mission specific needs. This adaptability is ev-
the authors as requiring FAST or E-FAST examinations. Fur- ident from the finding that the most frequent use of ultrasound
thermore, the literature review by Savell et al. discussed the in this retrospective review was for MSK purposes with 39 out
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specificity and sensitivity of military PoCUS use across various of 109 exams. When considering all “sick call”-related exams,
examination types, and concluded that military clinicians have including MSK, superficial assessments (covering skin and
demonstrated “the ability to perform focused exams, including minor wound care complaints), and “special exams” (such as

30 | JSOM Volume 25, Edition 2 / Summer 2025