Page 97 - JSOM Fall 2025

Vascular Ultrasonography Performed by

Special Operations Forces Combat Medics

A Feasibility Study

Benjamin L. Turner *; Jan Cornelis van de Voort, MD ;
1
2
Boke Linso Sjirk Borger van der Burg, MD, PhD ; Casper M. Fransen ;
4
3
Pieter-Jan A.M. van Ooij, MD, PhD ; Rigo Hoencamp, MD, PhD 6
5

ABSTRACT
Introduction: Two-dimensional venous ultrasound may be training technique for military medical personnel with little to
a viable substitute for standard Doppler ultrasonography in no ultrasound experience to obtain ultrasound images of the
monitoring and evaluating decompression stress. Preliminary IVC and PV. Our findings suggest that combat medics could
data possibly show that ultrasound recordings of the inferior perform vascular ultrasound measurements, which could be
vena cava (IVC) and popliteal vein (PV) can indicate elevated used to screen for high decompression stress in the future.
decompression stress. This study aims to evaluate the feasi-
bility of a microteaching program for training combat med- Keywords: ultrasound; special operations; decompression
ics to conduct ultrasound measurements on the IVC and PV stress; diving; microteaching
for self-monitoring of decompression stress on the waterside.
Methods: A vascular surgeon provided a microteaching course
to combat medics of the Netherlands Armed Forces. Two Introduction
Lumify (Philips Medical Systems International B.V., Best,
™
The Netherlands) handheld ultrasound devices were used, Descent under the water surface while diving exposes the body
connected to a Samsung Galaxy Tab A (generation 10.5, to external pressure. The increased pressure causes inert gases
™
Samsung, Suwon, South-Korea) or a Panasonic FZ-A2 tab- to dissolve and accumulate within tissue. When ascending to
™
let (Panasonic, Kadoma, Japan). The IVC was examined using the surface, the external pressure reduces, which causes dis-
the C5-2 abdominal probe, and the PV was assessed using the solved gases to emerge from solution. If depressurization hap-
L12-4 linear probe. Combat medics performed and recorded pens in an unordered way, for example, during a rapid ascent,
measurements observed by a vascular surgeon on their ran- the gases can precipitate and start to accumulate, forming gas
1
domly assigned partners after 2 minutes of practice. Three out- bubbles. The amount of bubbles entering the bloodstream
comes were measured in this study: (1) observer assessment of correlates to the amount of bubbles formed within the tissue,
the performance, (2) self-perceived procedure experience, and which can cause symptoms of decompression illness. Therefore,
(3) video recording quality scored by a vascular surgeon and the amount of venous gas emboli can be used as a marker for
researcher. Results: A total of 25 Special Operations Forces the amount of decompression stress experienced by the diver.
combat medics took part in this study. All but one participant
recorded the correct vessels. Recordings of the IVC and PV For decades, Doppler ultrasonography of the heart and sub-
were achieved in a mean time of 50 (SD 26) seconds and 1 clavian veins has been the standard to determine the post-dive
minute and 26 seconds (SD 55s), respectively. The participants bubble-load, resulting in diving tables specifying or recom-
2,3
didn’t report a difference in difficulty of obtaining a clear mending maximum dive times at certain depths. A disadvan-
image of either vessel. Both assessors assigned median and tage of this procedure is the requirement of highly experienced
modal scores of at least 4 out of 5 for all image quality cate- professionals and a controlled, noise-free environment. Two-
gories. Conclusion: This microteaching program is an effective dimensional venous ultrasound could be a promising alternative
*Correspondence to b.l.turner@student.vu.nl
1 Benjamin Leslie Turner is affiliated with the Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands. Jan Cornelis van
2
de Voort is affiliated with the Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands and the Trauma Research Unit, Department
of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands. Boke Linso Sjirk Borger van der Burg is affiliated
3
with the Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands and the Defense Healthcare Organisation, Ministry of Defense,
Utrecht, the Netherlands. Casper M. Fransen is affiliated with the Ministry of Defense, the Netherlands. Pieter-Jan A.M. van Ooij is affiliated
5
4
with the Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands and the Department of Respiratory Medicine, Amsterdam
UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands. Rigo Hoencamp is affiliated with the Diving Medical Centre,
6
Royal Netherlands Navy, Den Helder, the Netherlands, the Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands, the Defense
Healthcare Organisation, Ministry of Defense, Utrecht, the Netherlands, and the Trauma Research Unit, Department of Surgery, Erasmus MC,
University Medical Centre Rotterdam, Rotterdam, the Netherlands.
95