Combat Casualty Care and Out-of-Hospital Care Providers

Role of Ultrasonography in Combat Casualty Care and Out-of-Hospital Care

In the hands of trained military health system (MHS) practitioners, hand-carried ultrasound (HCUS) technology has proven to be a durable and reliable method of rapidly assessing critically ill patients within MHS facilities in the continental United States and during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). It is used domestically by MHS careproviders and by Forward Surgical Teams, Shock Trauma Platoons, expeditionary medical facilities, and within Combat Support Hospitals in OEF and OIF. (Blood, Brooks, Madill, Stamilio)  Brooks et al. documented the utility of Focused Assessment with Sonography in Trauma (FAST) by non-radiologists in a combat casualty care setting. (Brooks) It has also been reported as a method of avoiding unnecessary invasive procedures, such as needle decompression for presumed tension pneumothorax in out-of-hospital settings. (Do, Madill)

In addition, the military is progressively called upon to intervene in a variety of host-nation civilian care and humanitarian missions (e.g., post-earthquakes and tsunamis). Ultrasound is a well-documented method of improving field triage and initial assessment of patients in such out-of-hospital settings. (Beck-Razi, Dan, Dean, Huffer, Lyons, Raja, Miletic, Sarkisian, Sztajnkrycer). In view of the known utility and efficiency of HCUS in MHS clinical settings there exists the system-wide challenge of providing the requisite ultrasound training to the MHS cadre in a highly effective, uniform, and cost-effective manner.


Beck-Razi N, Fischer D, Michaelson M et al. The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war. J Ultrasound Med 2007;26:1149–1156.

Blood CG, Puyana JC, Pitlyk PJ et al. An assessment of the potential for reducing future combat deaths through medical technologies and training. J Trauma 2002;53(6):1160–1165.

Brooks AJ, Price V, Simms M. FAST on operational military deployment. Emerg Med J 2005 Apr;22(4):263-265.

Dan D, Mingson L, Jie T, et al. Ultrasongraphic applications after mass casualty incident caused by Wenchuan earthquake. J Trauma 2010 Jun;68(6):1417-1420.

Dean AJ, Ku BS, Zeserson. The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster. Am J Disaster Med 2007;2(5):249–256.

Do JR, McManus J, Harrison B. Use of ultrasonography to avoid an unnecessary procedure in the prehospital combat environment: A case report. Prehosp Emerg Care 2006 Oct-Dec;10(4):502-506.

Huffer LL, Bauch TD, Furgerson JL, et al. Feasibility of remote echocardiography with terminal satellite transmission and real-time interpretation to support medical activities in the austere medical environment. J Am Soc Echocardiogr 2004 Jun;17(6):670-674.

Lyon M, Blaivas M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med 2005 Jan;12(1):85-88.

Madill JJ. In-flight thoracic ultrasound detection of pneumothorax in combat. J Emerg Med 2010 Aug;39(2):194-197.

Miletic D, Fuchkar Z, Mraovic B, et al. Ultrasonography in the evaluation of hemoperitoneum in war casualties. Mil Med 1999 Aug;164(8):600-602.

Raja AS, Propper BW, Vandenberg SL, et al. Imaging Utilization during explosive multiple casualty incidents. J Trauma 2010 Jun;68(6):1421-1424.

Sarkisian AE, Khondkarian RA, Amirbekian NM et al. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma 1991;31:247–250.

Stamilio DM, McReynolds T, Endrizzi J, et al. Diagnosis and treatment of a ruptured ectopic pregnancy in a combat support hospital during Operation Iraqi Freedom: ase report and critique of a field-ready sonographic device. Mil Med 2004 Sep;169(9):681-683.

Sztajnkrycer MD, Baez AA, Luke A. Utility of ultrasonography in the triage of patients in the disaster setting: a preliminary study. Ann Emerg Med 2004 Oct;44(4):S36 Abstract.

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