Butterflies in the Field: Introducing Point-of-Care Ultrasound to Paramedics in Rural and Wilderness Emergency...

Paramedics in rural and wilderness environments often face prolonged transport intervals and limited resources, increasing the value of diagnostic tools like point-of-care ultrasound (POCUS). This is a prospective, quasi-experimental study with a one-group pretest-posttest design to assess the feasibility and utility of implementing extended focused assessment with sonography in trauma (eFAST) and limited cardiac ultrasound exams in these austere settings.

Twenty-four paramedics from a National Park Service unit and a local emergency medical services (EMS) agency underwent a blended POCUS training program, including asynchronous modules and hands-on instruction. Knowledge, attitudes, and practices (KAP) were assessed via pre/post-training surveys and tests, with a delayed knowledge test administered at four months. Scan utility was evaluated via post-scan hand-off surveys.

Participants demonstrated a 44% increase in knowledge scores immediately post-training (p < 0.0001), with good knowledge retention at four months post-training. Although KAP scores showed minimal change, qualitative feedback reflected strong enthusiasm for and perceived utility of prehospital POCUS. Twenty-two scans were performed during routine patient care. Four scans (18.2%) were deemed clinically meaningful by receiving physicians, influencing diagnosis and transport decisions.

Point of care ultrasound training for paramedics in rural and wilderness EMS settings is feasible, well-received, and results in successful use of POCUS for patient care and transport decision-making. Broader implementation and research may provide further insight to EMS clinician satisfaction, diagnostic accuracy and impact on patient outcomes in austere environments.