Enhancing Combat Support to Multidomain Operations

A Critical Appraisal and Proposal for Standardizing Point-of-Care Ultrasound Training for the US Army

By CPT Ryan A. Stevens MD, MBA, RDMS, MAJ Chelsea Ausman MD, RDMS, LTC Aicha Hull, MD, CPT Theodore McLean MD, LTC Melissa Myers, MD, MAJ Renato Rapada, DO and MAJ Kristine Jeffers, MD

Article published on: April 1, 2026 in the 2026 E-Edition of Pulse of Army Medicine

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Healthcare professionals are increasingly utilizing point-of-care ultrasound (POCUS), a dynamic tool that provides real-time imaging for diagnostic and procedural applications, which are vital for medical support in forward-deployed operations. This aligns with the Army Health System doctrine, which emphasizes the necessity of an agile force capable of adapting to a rapidly evolving multi-domain operational landscape. However, a significant capability gap persists: the absence of standardized POCUS training for both Army medical officers and enlisted personnel. There is a need to explore the potential of POCUS to enhance medical support for military operations.

A Fragmented Landscape: Current POCUS Training in the U.S. Army

POCUS training for clinicians within the U.S. Army is unevenly distributed and lacks standardized expectations and curricula, creating an opportunity to strengthen and enhance ultrasound training. Army Medicine must establish standards for the knowledge and skills required for POCUS to be ready for both current and future conflicts. Most formal POCUS instruction occurs in academic settings such as the Uniformed Services University (USU) or within select Graduate Medical Education (GME) residency programs, primarily Emergency Medicine and Family Medicine.

Beyond these pathways, a limited number of physicians and Physician Assistants complete Advanced Emergency Medicine Ultrasound (AEMUS) fellowships each year. The limited number of personnel trained in POCUS within the military has led to a widespread misunderstanding. Many trust that medical officers, regardless of specialized training, are fully equipped to handle the complete range of POCUS applications. This misconception is largely due to a general lack of understanding. The AEMUS fellowships, while valuable, are highly specialized programs that produce POCUS subject matter experts and administrative leaders capable of managing and teaching at GME programs beyond the scope of the general military clinician. From a military operational perspective, these fellowship-trained clinicians must lead the POCUS training programs that we have yet to officially establish.

The Urgent Need to Bridge the POCUS Training Gap

Rapid, accurate, and lightweight diagnostics are essential for forward-deployed personnel. POCUS provides that capability, making it a critical asset for mission success and directly impacting Soldier survivability (Curley, 2025). In austere environments where traditional imaging modalities like CT or MRI cannot be used due to size and weight constraints, POCUS provides a distinct advantage because it is far more deployable.

The use of ultrasound in Iraq and Afghanistan directly enhanced trauma care, and its role is expected to expand in future conflicts. In forward-deployed settings, POCUS is crucial for evaluating life-threatening conditions, including intra-abdominal hemorrhage, cardiac emergencies, and thoracic trauma. It is also indispensable for guiding decisions about resource allocation and evacuation priorities. For example, POCUS is a highly effective first-line tool for detecting pneumothorax, outperforming traditional chest radiography with a sensitivity of 86-91 percent compared with only 23-47 percent. This capability enhances casualty triage and helps conserve evacuation assets in contested environments. As noted, POCUS is paramount for rapid, efficient resource allocation in triage scenarios, allowing medical providers to quickly categorize patients by injury severity and optimize the use of limited medical and evacuation resources. Its portability and diagnostic accuracy make POCUS the preferred imaging tool for triage and evaluation in the field.

Additionally, POCUS allows medical providers to rule in or rule out pathology at the point of care, serving as a force conservation tool by preventing unnecessary medical evacuations and preserving scarce airframes for critically wounded personnel. It also enhances the safety and precision of life-saving procedures by enabling clinicians to perform with greater accuracy and confidence. For example, POCUS reduces time to successful vascular access, particularly for novice users. It also confirms endotracheal tube placement and guides nerve blocks, ultimately improving patient safety and reducing complications.

The operational argument for POCUS is reinforced by the Army’s emerging Ultrasound Field Portable (USFP) program. This program of record is a strategic initiative to field handheld diagnostic imaging capabilities to Role 1 and Role 2 units, formally bridging the gap between austere medicine and hospital-based diagnostics. Scheduled for fielding to Role 1 and Role 2 units beginning in Fiscal Year 2026, the USFP will use a portable solution weighing less than one pound. This information is timely and relevant to historical concerns regarding weight and logistical burden for the dismounted forward-deployed clinician. Furthermore, the planned integration of this device into the Medical Equipment Set (MES) acknowledges that in a PCC scenario involving evacuation delays, diagnostic blindness is a critical vulnerability.

Standardization of Training: A Solution-Based Proposal

To effectively address this critical gap, the Army must establish dedicated, standardized POCUS training for medical officers that clarifies expectations across the force. This solution aligns with Joint Publication covering health service support and the Army regulation for training and leader development, both of which emphasize the importance of standardized training and the integration of medical capabilities (Department of the Army, 2025; The Chairman of the Joint Chiefs of Staff, 2012). Below are four proposed courses of action (COAs). Across all recommended COAs, the course content covered should include seven core POCUS applications relevant to military medicine: Extended Focused Assessment with Sonography for Trauma (EFAST), ocular, cardiac, lung, vascular, musculoskeletal ultrasound, and procedural guidance (ACEP Ultrasound Section, 2016; Military Health System, 2025b, 2025a, 2025c). The curriculum must emphasize military-specific scenarios, such as battlefield trauma, mass casualty triage, and the use and logistics of POCUS in far-forward facilities.

Recommended Potential Courses of Action

COA 1: Develop an in-person POCUS training program for military clinicians.

A 40 to 80-hour course could provide the necessary standardized didactics and hands-on experience, focusing on core military-relevant applications. The advantage of this approach is its immediate operational impact; deploying clinicians would acquire directly applicable skills for battlefield trauma and mass casualty care. While highly effective, this model is resource-intensive, requiring a significant investment in dedicated instructors, equipment, and continuous course offerings to sustain the capability across the force.

COA 2: Integrate POCUS training directly into the military’s medical education pipeline.

By embedding instruction into medical school curricula, residency programs, and advanced practice provider education, this systematic approach would ensure every new clinician graduates with a standardized foundation in POCUS. The main advantage is that it creates a long-term pipeline of POCUS-trained clinicians across the entire force. However, this model would require a significant amount of time to design, disseminate the curriculum, and train faculty to a standard across military and civilian partner institutions. Additionally, this training pathway primarily targets individuals currently assigned to an educational setting, rather than all actively practicing clinicians, who would also benefit from POCUS training.

COA 3: Establish a doctrinal solution by creating an Army Medical Department (AMEDD) Training Circular (TC) for military medical clinicians training in POCUS.

This document would formalize standardized training expectations, define competency-based goals, and outline a transparent certification process that includes both theoretical and practical components. This approach is highly scalable and enduring. Once doctrine is published, it becomes the official standard for POCUS training and proficiency across the entire force, regardless of a clinician’s unit or location. This option would likely require extended time for implementation, given the need for extensive coordination and consensus among various stakeholders.

COA 4: Integrate POCUS training into the existing Tactical Combat Medical Care (TCMC) course.

TCMC is a five-day training program for medical professionals, including doctors, physician assistants, nurses, and medics. As the standard for wartime care, Tactical Combat Medical Care (TCMC) is also a readiness metric for many clinicians. Currently, the Extended Focused Assessment with Sonography for Trauma (EFAST) is taught in this course. By officially adding additional POCUS components to this well-established course, the Army could rapidly fill a critical training gap by leveraging its existing infrastructure. Critically, as the USFP device is slated for inclusion in the Medical Equipment Set (MES), aligning the course curriculum with the incoming material solution is essential to prevent a capability mismatch where equipment is fielded to untrained providers. While this approach offers the clear advantages of speed and feasibility, it is limited by the course length, as additional content may require rebalancing the current curriculum or expanding the course’s duration.

Standardize POCUS Training

Army clinicians lack standardized POCUS training, creating a critical capability gap that directly threatens readiness in future conflicts. It is a crucial tool for rapid diagnostics, time-sensitive interventions, and efficient triage, factors that directly impact medical logistics, Soldier survivability, and overall force lethality. By establishing a unified AMEDD training standard, Army Medicine can collectively advance toward the next generation of combat medical diagnostic capabilities, aligning our Army Health System with the broader vision of an agile, ready force capable of winning in multidomain operations. By acting now to synchronize standardized training with the incoming Ultrasound Portable Program (USFP) materiel solution, Army Medicine can ensure that every clinician is equipped with the POCUS skills of winning in multidomain operations. By acting now to synchronize standardized training with the incoming Ultrasound Portable Program (USFP) materiel solution, Army Medicine can ensure that every clinician is equipped with the POCUS skills necessary to save lives, conserve the fighting strength, and enable mission success in the most austere and contested environments.

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