Expeditionary Point-of-Care Ultrasound for Combat and Austere Environments.

Area of Science:

• Military Medicine
• Point-of-Care Ultrasound
• Expeditionary Medicine

Background:

• Civilian Point-of-Care Ultrasound (POCUS) standards do not meet battlefield constraints.
• Expeditionary POCUS (E-POCUS) is emerging as a distinct capability for combat environments.

Purpose of the Study:

• To delineate Expeditionary POCUS (E-POCUS) as a distinct capability.
• To identify gaps in current E-POCUS standardization and propose solutions.

Main Methods:

• Systematic scoping review following PRISMA-ScR guidelines.
• Searched major databases (PubMed, Embase, Web of Science, Google Scholar) through November 2025.
• Included studies from terrestrial austere and combat environments; excluded hospital-based studies. Assessed quality using a modified GRADE framework.

Main Results:

• Fifty-three studies met inclusion criteria; data primarily from civilian resource-limited settings (34%) and military zones (26%).
• Methodological quality was polarized, with AI-assisted acquisition supported by high-quality trials and trauma protocols by low-quality models.
• Critical gaps identified in standardization of E-POCUS equipment, training, and application in austere/combat environments.

Conclusions:

• Expeditionary POCUS (E-POCUS) necessitates a doctrine separate from civilian standards.
• A Best, Better, Minimum competency matrix is proposed for standardizing training and equipment allocation.
• Future research must validate these frameworks and quality improvement initiatives for sustainable E-POCUS training.