The impact of prehospital ultrasound performed by paramedics on triage and clinical decision-making in hemodynamically unstable patients: a narrative review with real-life paramedic-performed cases

Abstract

In the prehospital setting, hemodynamic instability presents a major diagnostic challenge for emergency medical teams because rapid differentiation between underlying causes is often required in the absence of advanced diagnostic tools. Targeted point-of-care ultrasound (POCUS) protocols have emerged as a valuable addition to clinical assessments, providing real-time evaluations of potentially reversible, life-threatening conditions at the bedside. This study combines a narrative review of the current evidence with a real-life case series to explore the role of POCUS in assessing hemodynamically unstable patients. The narrative review highlights the growing body of literature supporting the use of POCUS in differentiating major categories of shock, including hypovolemic, obstructive, and cardiogenic etiologies. However, it also acknowledges the limited number of randomized controlled trials and the heterogeneity of available data. To complement this evidence, we present a series of patients in whom prehospital POCUS enabled rapid diagnosis, guided targeted treatment, and informed appropriate hospital allocation. These cases demonstrate the practical application of POCUS in various critical conditions, such as acute coronary syndrome, pulmonary embolism, pneumothorax, severe aortic stenosis, hypovolemia, and cardiac tamponade. Together, these findings support the hypothesis that POCUS performed by trained paramedics can provide clinically meaningful diagnostic information and facilitate early differential diagnosis in patients with hemodynamic instability. Although the evidence is currently observational, integrating POCUS into prehospital care pathways could improve decision-making in time-critical situations, which warrants further investigation in prospective studies.