Point-of-Care Ultrasound Education and Use in Conflict Settings: Lessons From the War in Ukraine

Introduction Point-of-care ultrasound (POCUS) has a well-established role in acute medical care and is particularly valuable in conflict zones where access to advanced imaging is limited. To aid Ukrainian healthcare providers, POCUS courses were implemented, and doctors received education and ultrasound probes to use on the frontlines. The objectives of this study were to evaluate the use of POCUS by novice users in conflict-related medical environments, using the war in Ukraine as a case study. We sought to identify how and where medical personnel use ultrasound after an introductory POCUS course, and what barriers to use exist. Methods This was a cross-sectional survey of former participants in two-day POCUS training courses organized by Razom for Ukraine and the Christian Medical Association of Ukraine between January 2023 and September 2024. Applications taught included Focused Assessment with Sonography for Trauma (FAST), cardiac, lung, deep vein thrombosis (DVT), soft tissue, renal, hepatobiliary, soft tissue, nerve blocks, vascular access, musculoskeletal, and ocular. All course participants were medical personnel managing soldiers injured in battle. A link to the survey was distributed by Telegram, a messaging platform. Participation was voluntary and anonymous. This research was deemed to be exempt by the Institutional Review Board (IRB). Results The survey was sent to 352 participants. A total of 40% (140/352) of participants responded, of which 87% (122/140) were doctors. Participants worked in stabilization points (56%, 78/140), in military hospitals (31%, 43/140), and in medical transport (14%, 19/140). A total of 64% (89/140) used POCUS at least once a day. The most commonly used applications were FAST (89%, 124/140), pneumothorax (72%, 101/140), vascular access (62%, 87/140), soft tissue (54%, 75/140), and nerve blocks (44%, 62/140). The most common educational barriers to use were image interpretation (47%, 66/140) and image acquisition (31%, 44/140). The most common technological problems were damage to the probe or cord (36%, 50/140), a short battery lifespan (32%, 45/140), and not having access to a machine (26%, 36/140). Conclusions After a brief training, novice users regularly used POCUS in the care of wounded soldiers in Ukraine. FAST, pneumothorax, vascular access, soft tissue, and nerve blocks were the most frequently used applications. Future efforts should focus on additional education on image interpretation and acquisition, and on procurement of more ultrasound machines.