Readiness for prehospital Point-of-care ultrasound among EMS personnel in a system where ultrasound is not yet implemented: a National cross-sectional survey

Abstract

Point-of-care ultrasound (POCUS) is increasingly used in emergency and critical care for rapid, radiation-free bedside imaging. However, its integration into prehospital emergency medical services (EMS) remains inconsistent, particularly in paramedic-based systems where physician support is limited. This study evaluated the knowledge, attitudes, and readiness of EMS personnel toward adopting POCUS in a national prehospital system where ultrasound has not yet been implemented. METHODS: A descriptive, cross-sectional survey was conducted between March and August 2023 among prehospital EMS professionals working in Türkiye’s national emergency medical services system, where prehospital ultrasound is not routinely implemented. A 27-item online questionnaire assessed demographics, previous ultrasound training and use, perceived diagnostic applications, and barriers to field implementation. Quantitative data were analyzed descriptively and compared using chi-square tests, while qualitative responses underwent thematic analysis. RESULTS: A total of 156 EMS professionals participated, most being paramedics (73.1%) working in urban settings (58.3%). Only 21.2% had prior ultrasound training and 22.4% hands-on experience. Nevertheless, 95.5% expressed willingness to receive training, and 90.4% reported interest in using POCUS during prehospital care. The most prioritized applications were intra-abdominal hemorrhage (96.2%), pneumothorax (82.7%), aortic aneurysm (85.3%), and cardiac tamponade (80.1%). Key barriers included lack of equipment, limited training opportunities, and lack of clear regulatory guidelines and defined scope of practice for EMS personnel regarding ultrasound use. CONCLUSION: EMS personnel in a paramedic-based prehospital system demonstrated high readiness but limited exposure to POCUS. Structured training programs, pilot implementation projects, and clear regulatory frameworks may support the safe and effective integration of ultrasound into prehospital emergency care.