This week, Aebhric O'Kelly speaks with three combat medics from Tactical Medicine North following a Tactical APUS instructor development programme in Malta. The discussion explores whether ultrasound can be taught to non-medical personnel operating in combat environments, including Combat Lifesavers (CLS) and Combat Medic Corpsmen (CMC), and how ultrasound may support prolonged casualty care, triage, and telemedicine in Ukraine.
The conversation challenges traditional assumptions regarding ultrasound education, introduces the Tactical APUS concept, discusses modifications to the standard eFAST examination sequence, and reviews preliminary observations from a study comparing parasternal long-axis (PLAX) and subxiphoid cardiac views.
Chapters
00:00 – Introduction
01:06 – Can Non-Medics Learn Ultrasound?
03:00 – Lessons from the APUS Course
05:30 – The Power of Home Points07:50 – What is Tactical APUS?
10:00 – Adapting eFAST for Combat Operations
12:30 – Hypothermia Prevention During Ultrasound
15:20 – The Controversial Change: Heart Last
20:00 – PLAX vs Subxiphoid Cardiac Views
24:40 – Teaching Maltese Nurses
29:10 – Should We Teach Ultrasound to Combat Lifesavers?
32:20 – Ultrasound as a Triage Tool
35:10 – Advice for Future Tactical Ultrasound Providers
38:00 – Closing Remarks
Key Takeaways
The parasternal long-axis cardiac viewappears easier for novice learners than the traditional subxiphoid view.
Overview of the APUS and Tactical APUS training programme conducted in Malta.
Discussion on teaching eFAST ultrasound to Combat Lifesavers and Combat Medic Corpsmen.
Comparison with early challenges teaching combat medicine to personnel without formal medical backgrounds.
Importance of simple teaching techniques and instructor adaptability.
Introduction of the "Home Point" concept for each eFAST window.
How home points help students recover when they become disoriented during scanning.
Development of a one-day ultrasoundcurriculum for tactical providers.
Focus on eFAST as a trauma tool for prolonged field care and telemedicine support.
Discussion of modifying the traditional eFAST sequence.
Prioritising lung assessment over cardiac views.
The dangers of exposing casualties during scanning.
Importance of maintaining casualty insulation and minimising gel exposure.
Why the Tactical APUS team moved cardiac assessment after lung assessment.
Students consistently finding the parasternal long-axis view easier to obtain.
Experience using Maltese nurses as pilot students.
Differences between teaching healthcare professionals and non-medical personnel.
Language barriers and instructional adaptations.
Moving beyond "Can we?" to "Should we?"
Ultrasound as a prolonged casualty care and telemedicine tool.
Supporting decision-making during extended evacuations.
Using eFAST to prioritise casualties during mass casualty situations.
Early identification of internal bleedingand pneumothorax.
Potential role of optic nerve sheath diameter (ONSD) assessment in blast-related head injuries.
Importance of accessibility of handheld ultrasound devices.
The role of deliberate practice and repetition in ultrasound mastery.
Reflections on the success of the Tactical APUS pilot programme.
Future collaboration between CoROM and Tactical Medicine North.
Final thoughts from the Ukrainian instructors.
Ultrasound can be successfully taught to Combat Lifesavers and Combat Medic Corpsmen when training is focused on pattern recognition and image acquisition rather than advanced interpretation.
"Home Points" provide a powerful cognitive aid for novice sonographers.
Lung ultrasound may provide greater battlefield utility than cardiac ultrasound because interventions can be performed immediately.
Hypothermia prevention must remainintegrated into all ultrasound training and operational use.
