Rapid Ultrasound Augmented Triage for Special Operations Casualties

In resource-limited combat of future near peer war mass casualty scenarios, rapid identification of salvageable casualties requiring immediate intervention is critical. Prehospital needle decompression demonstrates high failure rates (58-64%) and is frequently performed based on subjective criteria, with only 30-48% of patients showing clinical response.(1) Similarly, identifying internal hemorrhage requiring blood products remains challenging in austere environments where hypotension is a poor indicator until >30% blood volume loss has occurred.(2) Point-of-care ultrasound (POCUS) offers 87-98% sensitivity and 99-100% specificity for detecting hemoperitoneum and can identify pneumothorax with greater sensitivity than chest x-ray.(3) We hypothesized that a focused three-view POCUS protocol could rapidly identify the minority of casualties requiring immediate decompression or blood products while avoiding unnecessary interventions in non-salvageable patients.