Feasibility of a Condensed Training Program Enabling Combat Medics to Acquire Telemedicine-Ready E-FAST Images: A...

Battlefield trauma remains a leading cause of preventable death, with hemorrhage and tension pneumothorax accounting for the majority of potentially survivable fatalities. A telemedicine-enabled workflow, in which combat medics acquire Extended Focused Assessment with Sonography for Trauma (E-FAST) images for transmission to a remote physician, represents a pragmatic solution to the diagnostic gap at the point of injury. The operational viability of this model depends critically on whether non-physician medics can reliably acquire interpretable images following brief, focused training. We hypothesized that a structured 4-hour training program would enable ultrasound-naïve combat medics to achieve a telemedicine-ready image acquisition rate of ≥80% across all 6 standard E-FAST windows.

This prospective, single-center pilot educational intervention enrolled 20 FAST-naïve male combat medics (mean age 29.2 ± 2.4 years). The single-day intervention, structured according to the TIDieR framework, comprised a 4-hour didactic session followed by individualized hands-on practice to competency. The curriculum targeted standardized image acquisition rather than independent interpretation, minimizing cognitive load by decoupling psychomotor acquisition from diagnostic reasoning. Performance was assessed immediately post-training (T1) and at 4 weeks (T2). Each participant independently acquired 6 standard E-FAST windows on healthy volunteer models. Two independent, blinded emergency physicians rated each window using a validated 15-point rubric (3 domains on a 1-5 Likert scale, adapted from the QUICk framework). The primary outcome was the window-level rate of telemedicine-ready acquisition, defined a priori as both raters assigning ≥12/15 to a given window. Between time point comparisons accounted for within-subject clustering using Generalized Estimating Equations (GEE). Interrater reliability was assessed using ICC (2,1).

The overall telemedicine-ready acquisition rate was 83.3% (100/120 windows; 95% CI, 75.7%-88.9%) at T1 and 85.8% (103/120; 95% CI, 78.5%-91.0%) at T2, meeting the a priori ≥80% hypothesis threshold at both time points. Competency was highest for the pelvic/bladder (100%) and right upper quadrant (95%) windows at both assessments. The left upper quadrant window was most challenging (50% at T1; 60% at T2). At the participant level, 9/20 (45%) achieved telemedicine-ready acquisition in all 6 windows at T2, and 15/20 (75%) in at least 5 of 6. GEE modeling confirmed no significant change in acquisition probability between time points (adjusted OR 1.18; 95% CI, 0.82-1.70; P = .384). Total rubric scores were stable (P = .312). Median examination time decreased significantly from 108.5 s (IQR 88.0-139.0) to 104.0 s (IQR 86.5-131.0) at T2 (Wilcoxon signed-rank test: P = .003; effect size r = 0.47). Interrater reliability was good to excellent across all windows (ICC range: 0.854-0.976).

This preliminary, single-day, acquisition-focused training program enabled ultrasound-naïve combat medics to acquire E-FAST images of sufficient quality for remote expert interpretation, with short-term retention demonstrated at 4 weeks. These findings provide proof of concept support for the image acquisition component of a telemedicine-based battlefield trauma assessment system. Future research should evaluate the complete telemedicine workflow, including image transmission under tactical field conditions, remote interpretation accuracy, and the impact on clinical decision-making and patient outcomes.