Feasibility of a Condensed Training Program Enabling Combat Medics to Acquire Telemedicine-Ready E-FAST Images: A Prospective Pilot Educational Intervention

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ID: 319918
2026
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Abstract
INTRODUCTION: Battlefield trauma remains a leading cause of preventable death, with hemorrhage and tension pneumothorax accounting for the majority of potentially survivable fatalities. A telemedicine-enabled workflow, in which combat medics acquire Extended Focused Assessment with Sonography for Trauma (E-FAST) images for transmission to a remote physician, represents a pragmatic solution to the diagnostic gap at the point of injury. The operational viability of this model depends critically on whether non-physician medics can reliably acquire interpretable images following brief, focused training. We hypothesized that a structured 4-hour training program would enable ultrasound-naïve combat medics to achieve a telemedicine-ready image acquisition rate of ≥80% across all 6 standard E-FAST windows. MATERIALS AND METHODS: This prospective, single-center pilot educational intervention enrolled 20 FAST-naïve male combat medics (mean age 29.2 ± 2.4 years). The single-day intervention, structured according to the TIDieR framework, comprised a 4-hour didactic session followed by individualized hands-on practice to competency. The curriculum targeted standardized image acquisition rather than independent interpretation, minimizing cognitive load by decoupling psychomotor acquisition from diagnostic reasoning. Performance was assessed immediately post-training (T1) and at 4 weeks (T2). Each participant independently acquired 6 standard E-FAST windows on healthy volunteer models. Two independent, blinded emergency physicians rated each window using a validated 15-point rubric (3 domains on a 1-5 Likert scale, adapted from the QUICk framework). The primary outcome was the window-level rate of telemedicine-ready acquisition, defined a priori as both raters assigning ≥12/15 to a given window. Between time point comparisons accounted for within-subject clustering using Generalized Estimating Equations (GEE). Interrater reliability was assessed using ICC (2,1). RESULTS: The overall telemedicine-ready acquisition rate was 83.3% (100/120 windows; 95% CI, 75.7%-88.9%) at T1 and 85.8% (103/120; 95% CI, 78.5%-91.0%) at T2, meeting the a priori ≥80% hypothesis threshold at both time points. Competency was highest for the pelvic/bladder (100%) and right upper quadrant (95%) windows at both assessments. The left upper quadrant window was most challenging (50% at T1; 60% at T2). At the participant level, 9/20 (45%) achieved telemedicine-ready acquisition in all 6 windows at T2, and 15/20 (75%) in at least 5 of 6. GEE modeling confirmed no significant change in acquisition probability between time points (adjusted OR 1.18; 95% CI, 0.82-1.70; P = .384). Total rubric scores were stable (P = .312). Median examination time decreased significantly from 108.5 s (IQR 88.0-139.0) to 104.0 s (IQR 86.5-131.0) at T2 (Wilcoxon signed-rank test: P = .003; effect size r = 0.47). Interrater reliability was good to excellent across all windows (ICC range: 0.854-0.976). CONCLUSIONS: This preliminary, single-day, acquisition-focused training program enabled ultrasound-naïve combat medics to acquire E-FAST images of sufficient quality for remote expert interpretation, with short-term retention demonstrated at 4 weeks. These findings provide proof of concept support for the image acquisition component of a telemedicine-based battlefield trauma assessment system. Future research should evaluate the complete telemedicine workflow, including image transmission under tactical field conditions, remote interpretation accuracy, and the impact on clinical decision-making and patient outcomes.
Reference Key
openalex_W7167642707 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Mehmet Tatlı, Ertuğ Günsoy, Ömerul Faruk Aydın, Mehmet Necmeddin Sutaşır
Journal Military Medicine
Year 2026
DOI
10.1093/milmed/usag314
URL
https://doi.org/10.1093/milmed/usag314
Keywords Keywords not found

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