Prehospital point-of-care ultrasound as a decision-support tool: A structured narrative review

Point-of-care ultrasound (POCUS) may support focused bedside decisions, but prehospital implementation remains limited by operational constraints, heterogeneous protocols, variable training, and limited outcome-focused evidence. This narrative review examines prehospital POCUS as a clinical decision-support tool across cardiac, thoracic, trauma, pediatric, and obstetric applications.

A structured narrative review was conducted in MEDLINE/PubMed, Embase, and Cochrane Central from April 2017 to February 2026. Search terms combined the prehospital setting, ultrasound, and clinical applications. Of 464 records identified, 38 full-text articles were included, including nine systematic reviews on cardiac evaluation (n = 2), thoracic evaluation (n = 3), and trauma assessment (n = 4). Screening and full-text assessment were performed by a single reviewer. No formal risk-of-bias assessment, certainty grading, quantitative synthesis, or meta-analysis was performed.

In cardiac arrest, prehospital POCUS may identify cardiac activity and selected reversible causes, guide interventions, confirm return of spontaneous circulation, and support prognostic assessment, provided that image acquisition does not interrupt resuscitation or delay defibrillation. In nontraumatic shock and cardiac dysfunction, focused cardiac, lung, and vascular ultrasound may help characterize shock mechanisms, guide fluid therapy, and identify actionable findings such as pulmonary congestion, pericardial effusion, right ventricular strain, or major aortic pathology. In acute dyspnea, lung ultrasound may improve diagnostic confidence, particularly for cardiogenic pulmonary edema. In trauma, E-FAST has high specificity and may support triage, destination choice, trauma pathway activation, and preparation for definitive care; however, limited sensitivity prevents its use as a rule-out test. Pediatric and obstetric applications are feasible but remain emerging.

Prehospital POCUS is an adjunctive decision-support tool rather than a standalone diagnostic test. Its value lies in answering actionable questions that may influence treatment, triage, transport destination, hospital prealert, or pathway activation. Implementation requires protocols, training, quality assurance, and governance, and must not delay time-critical care or transport.