Ultrasonography in disaster medicine: a narrative review

This narrative review aimed to critically appraise the diagnostic accuracy, clinical impact, and operational feasibility of ultraportable point-of-care ultrasonography (POCUS) across the four domains of disaster medicine. A literature search was conducted following the SANRA and PRISMA-trAIce guidelines. Records were identified through an AI-assisted literature-discovery tool (the Undermind Deep-Search platform, interrogating the Semantic Scholar corpus) run on 15 June 2025, rather than through an independent structured multi-database search. Candidate references were screened manually against pre-specified eligibility criteria by a single reviewer, with the search parameters independently verified by the senior author. Of 71 records identified, 63 met the inclusion criteria. The included studies comprised 32 original studies, 10 systematic or scoping reviews, 20 narrative or operational papers, and one guideline. In CBRN scenarios, lung ultrasound demonstrated sensitivities of 90-97% for COVID-19 pneumonia versus 60-69% for chest radiography while minimizing healthcare worker exposure. For blast and ballistic injuries, FAST showed a pooled sensitivity of 92.1% (95% CI: 87.8-95.6) and specificity of 98.7% (95% CI: 96.0-99.9) for intra-abdominal hemorrhage. In natural disasters, ultrasound altered management in up to 44% of patients. Post-disaster applications included vascular access, tube confirmation, and complication monitoring. Ultraportable POCUS demonstrates diagnostic utility and operational feasibility across multiple disaster domains. However, evidence quality varies significantly, and standardized protocols remain lacking. Prospective studies linking ultrasound deployment to improved patient outcomes are needed. KEY POINTS: Question When disasters disable conventional imaging, how does ultraportable point-of-care ultrasonography perform for diagnosis, triage, and procedural guidance across the four domains of disaster medicine? Findings Across 63 studies, FAST reached 92.1% pooled sensitivity for hemoperitoneum, lung ultrasound 90-97% versus 60-69% for radiography; management changed in up to 44%. Critical relevance statement This review critically appraises ultraportable ultrasound across all four disaster domains, showing that radiation-free bedside imaging accelerates triage, conserves scarce CT capacity, and extends radiological expertise through tele-guidance, while exposing an evidence base still lacking prospective outcome data.