Imaging modalities in the prehospital setting are helpful in the evaluation and management of time-sensitive emergency conditions. Ultrasound is the main modality that has been applied by emergency medical services (EMS) providers in the field. This paper examines the clinical applications of ultrasound in the prehospital setting. Specific focus is on applications that provide essential information to guide triage and management of critical patients. Challenges of this modality are also described in terms of cost impact on EMS agencies, provider training, and skill maintenance in addition to challenges related to the technical aspect of ultrasound. 1. Introduction Emergency ultrasound performed by nonradiologists has been widely adopted in most emergency departments (EDs) across the United States (US) and the world with a continuously growing list of diagnostic and therapeutic applications [1]. This technology enables emergency physicians to answer focused clinical questions at the bedside, which would translate into faster and more accurate diagnosis and care of patients presenting with time-sensitive emergency conditions. Better outcomes have been reported with the use of emergency ultrasound [2]. The use of this technology in the prehospital setting is increasing with reports of physicians and nonphysicians performing diagnostic and therapeutic interventions in different emergency medical services (EMS) systems across Europe and the United States [3]. This was facilitated by the portability of modern ultrasound machines that have small, lightweight, and durable designs and that deliver high-quality and high-resolution imaging. Like any other intervention, the addition of ultrasound machines to the armamentarium of prehospital providers raises several questions in terms of potential clinical applications, feasibility, training requirements, cost, and more importantly its impact on the care process and on patient outcome. The type of EMS system that is in place, whether it follows the Anglo-American model or the Franco-German one, is an important factor to consider when discussing any prehospital intervention including prehospital ultrasound [4]. This paper reviews the available literature about current applications of ultrasound use in the prehospital setting and discusses challenges, limitations, and potentials of prehospital emergency ultrasound. The evidence presented is specific to emergency ultrasound performed in the prehospital setting and does not reflect the available evidence for all the medical indications and emergency or critical medicine
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