Page 33 - JSOM Summer 2025

TABLE 2 Literature Review Descriptive Results
No. (%) of articles
Total Diagnostic Procedural Operational Advocating use
Neurologic 2 (10.0) 1 (50.0) 1 (50.0) 1 (50.0) 1 (50.0)
Respiratory 3 (15.0) 3 (100.0) 0 (0.0) 0 (0.0) 3 (100.0)
Cardiovascular 10 (50.0) 1 (10.0) 9 (90.0) 4 (40.0) 6 (60.0)
Abdominal 4 (20.0) 4 (100.0) 0 (0.0) 3 (75.) 1 (25.0%)
Musculoskeletal 7 (35.0) 7 (100.0) 1 (14.3) 5 (71.4) 2 (28.6)
Total by article 20 13* (56.5) 10* (43.5) 8† (40.0) 12 (60.0)
†
Note: Some percentage totals are greater than 100 due to some articles having more than one descriptive category.
*13 is actual count of number of articles with diagnostic use and not sum of column. The discrepancy is due to some diagnostic articles describing
diagnostic use in multiple organ systems. Subsequently the percentage is ratio of 13/23, where 3 articles were both diagnostic and procedural so
total 23.
† Total article count is not equal to sum of column values due to some articles discussing more than a single system. In this case percentage cal-
culation uses total articles of 20.

fetal viability, retinal detachment, and nephrolithiasis), these SOCM practice. This absence of supporting literature does not
collectively accounted for 69 out of the 109 performed exams. diminish the importance of SOCMs learning this exam, but it
The authors noted that the training for these “sick call” exams highlights why this examination may not offer the same level
was a minor component of the SOCM ultrasound training and of significance to SOCMs as it does to in-hospital providers.
that “these medics recognized the relevance of this seemingly
insignificant application to their practice.” This finding that A notable difference in these literature review findings com-
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the 18Ds used ultrasound to augment their mission-specific pared to the retrospective study by Morgan et al. is the propor-
needs, which for special forces medics includes a substantial tion of procedure-based ultrasound described. In the Morgan
amount of sick call/clinic, is striking and relevant. et al. retrospective study, only 3 of the 109 exams were clas-
sified as procedural. The authors reported that this was ex-
Finally, it is noteworthy that abdominal and trauma assess- pected given the pre-deployment curriculum “only briefly
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ments (E-FAST comprising abdominal, cardiac, and pneumo- covered these subjects.” In contrast, in this literature review,
thorax evaluation) with ultrasound constituted only 34 out of 90% of the most common reported organ system use, cardio-
the 109 exams conducted by the 29 SOCMs throughout an vascular, was procedural, and 43.5 % of all articles were pro-
entire deployment. This is despite the E-FAST exam being the cedure-based. Further, most of the diagnostic exams, outside
most extensively covered content in the pre-deployment ultra- of the MSK exams, were ones that would directly lead to a
sound training. The authors explained this unexpected finding procedure or SOCM scope of practice intervention: neurologic
by stating: “In our mature theater, most patients with pene- assessment for intercranial pressure would potentially lead to
trating or serious blunt injuries were empirically evacuated. hypertonic intravenous infusions; the three articles describing
An abdominal ultrasound was unlikely to influence the evacu- assessment for pneumothorax would lead to chest tube or nee-
ation decision in an environment with established MEDEVAC dle decompression; the sole cardiovascular diagnostic descrip-
procedures.” 9 tion of an E-FAST with the finding of a possible pericardial
effusion could lead to pericardiocentesis depending on the cir-
When collectively evaluating the results of this literature review, cumstances. Finally, the only described abdominal exam that
we found they align with the findings presented in the article by led to a change in management was the single procedure-based
Morgan et al. First, within this review, 35% of the included ar- article describing REBOA use. 21
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ticles described MSK-related ultrasound examinations, making
it the second most common topic covered, following only car- The findings of this literature review provide insight into
diovascular ultrasound, which comprised 50% of the included how SOCM training may be improved. First, individual units
articles. This likely represents publications reflecting the 18Ds’ should reflect on specific unit mission characteristics when de-
adaptation to using ultrasound for the Special Forces’ unique veloping an ultrasound training program for their unit and
mission set. Secondly, the author found limited references to mission. In addition, this review suggests that, when training
the E-FAST examination being advocated for (1 article) or an SOCM unit to use ultrasound, a more substantial emphasis
used by SOCMs (3 articles). Notably, there were no articles on procedural training may be beneficial. In particular, the au-
exclusively covering abdominal ultrasonography; instead, the thor would advocate for: increased training in regional anes-
articles mentioned the E-FAST examination while discussing thesia for pain control especially among units that have a high
general or other system ultrasound applications. Furthermore, likelihood of treating trauma; ultrasound guidance for chest
among the three operational descriptions: the Morgan et al. ar- tube placement or needle decompression and for assistance
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ticle concluded that abdominal ultrasound was not common ; in establishing emergency airway access; and ultrasound for
the paper by McLeroy et al. merely mentioned the performance venous access and consideration for assessment and possible
of an E-FAST exam and the potential finding of a pericar- control of ongoing hemorrhage.
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dial effusion; and finally the Manley et al. article, although
mentioning the E-FAST exam, focused on the placement of a This review has multiple limitations. First, the author identified
REBOA device by a surgical team (physician) in the setting of a limited number of articles describing both current and pro-
hemoperitoneum. Ultimately, there is a lack of literature sup- posed SOCM ultrasound use, and many of the articles found
porting the notion that the E-FAST examination significantly did not meet high-level evidence standards. Consequently, any
alters the management of abdominal pathology in current conclusions regarding SOCMs use of ultrasound in clinical

A Review of JSOM Articles on Ultrasound Use by SOCM | 31