Vascular Ultrasonography Performed by Special Operations Forces Combat Medics: A Feasibility Study

Two-dimensional venous ultrasound may be a viable substitute for standard Doppler ultrasonography in monitoring and evaluating decompression stress. Preliminary data possibly show that ultrasound recordings of the inferior vena cava (IVC) and popliteal vein (PV) can indicate elevated decompression stress. This study aims to evaluate the feasi-bility of a microteaching program for training combat med-ics to conduct ultrasound measurements on the IVC and PV for self-monitoring of decompression stress on the waterside.

A vascular surgeon provided a microteaching course to combat medics of the Netherlands Armed Forces. Two Lumify® (Philips Medical Systems International B.V., Best, The Netherlands) handheld ultrasound devices were used, connected to a Samsung Galaxy Tab A® (generation 10.5, Samsung, Suwon, South-Korea) or a Panasonic FZ-A2® tablet (Panasonic, Kadoma, Japan). The IVC was examined using the C5-2 abdominal probe, and the PV was assessed using the L12-4 linear probe. Combat medics performed and recorded measurements observed by a vascular surgeon on their randomly assigned partners after 2 minutes of practice. Three outcomes were measured in this study: (1) observer assessment of the performance, (2) self-perceived procedure experience, and (3) video recording quality scored by a vascular surgeon and researcher.

A total of 25 Special Operations Forces combat medics took part in this study. All but one participant recorded the correct vessels. Recordings of the IVC and PV were achieved in a mean time of 50 (SD 26) seconds and 1 minute and 26 seconds (SD 55s), respectively. The participants didn't report a difference in difficulty of obtaining a clear image of either vessel. Both assessors assigned median and modal scores of at least 4 out of 5 for all image quality categories.

This microteaching program is an effective training technique for military medical personnel with little to no ultrasound experience to obtain ultrasound images of the IVC and PV. Our findings suggest that combat medics could perform vascular ultrasound measurements, which could be used to screen for high decompression stress in the future.