Effectiveness of a Simulation-based Point-of-care Ultrasound Course for Prehospital Providers - A Single Group Quasi-Experimental Study

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Rodriguez, Angel “Al” Brotons, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5831070/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted 7 You are reading this latest preprint version Abstract Objective Emergency medical service (EMS) professionals are increasingly using point-of-care ultrasound (POCUS) into the prehospital management and triage of critically ill patients. However, few institutions offer organized POCUS training for this community. Our goal was to offer and evaluate the effectiveness of a simulation-based POCUS course for EMS professionals. Methods We developed and implemented an eight-hour course to train EMS providers in the fundamentals of POCUS for blunt trauma patients. The course design included lectures, standardized patients hands-on scanning, simulation-based ultrasound cases, clinical cases based on real patients, and an end-of-course review game. Before the day of the course, participants were assigned e-learning modules on the fundamentals of POCUS and on the Extended Focused Assessment with Sonography for Trauma Exam (eFAST). The effectiveness of the course was evaluated using Kirkpatrick’s methodology for Level 1 (course evaluation by participants) and Level 2 (pre- and post-course knowledge assessments including image interpretation). Pre- and post-knowledge scores were presented using means and ranges. Percent improvements and a paired sample t-test with the effect size (Cohen’s d) were used to compare pre-post improvements. For course evaluation ratings, the mean Likert scale rating was calculated. Results A total of 128 learners (103 paramedics, 22 flight nurses, and one EMS physician from 32 EMS agencies, as well as two United States Army medics, completed the course. The average age of participants was 39.0 years, and 98 (76.6%) were male. The pre-course assessment mean knowledge score was 67.6% (95% CI 64.7–70.5). The post-course mean knowledge score was 89.0% (95% CI 87.3–97.0), resulting in the 21.4 percentage point increase (p < .001; Cohen’ s d = 1.52). We received 122 course evaluations. Participants expressed nearly unanimous strong agreement across all measures, with a mean rating ranging from 4.8 to 4.9 on a 5-point Likert scale questionnaire. Conclusions Our data suggests that an 8-hour POCUS course, incorporating e-learning and simulation, can significantly improve EMS providers’ knowledge of the fundamentals of POCUS and image interpretation of eFAST examination in trauma patients. Course evaluation results are highly supportive of this course’s benefits. As EMS agencies increasingly incorporate POCUS for patient care, effective and efficient training methodologies will be critical for successful implementation. Our course offers one approach as part of a comprehensive training program. Further studies should assess POCUS utilization and sustained knowledge retention. Point-of-care ultrasound POCUS Simulation Medical education Prehospital ultrasound EMS education Extended Focused Assessment with Sonography for Trauma Air rescue Figures Figure 1 Figure 2 Figure 3 Background Point-of-care ultrasound (POCUS) is integral to the assessment and evaluation of critically ill patients [ 1 ]. The technology allows clinicians to quickly and efficiently identify intra-abdominal and intra-thoracic injuries, including those from blunt or penetrating trauma. The Extended Focused Assessment with Sonography in Trauma (eFAST) has become a gold standard for early screening in trauma [ 2 ]. An experienced operator can perform an eFAST in under three minutes with approximately 93% sensitivity and 99% specificity for detecting free fluid in the abdomen and/or pericardial space [ 3 , 4 ]. The use of POCUS by emergency medical services (EMS) has been extensively studied in United Kingdom, Germany, France, and Italy [ 4 – 11 ]. In these countries physicians often spend more time on the scene, evaluating and treating patients using POCUS as an adjunct for triage, patient assessment, and management in the field [ 5 , 6 ]. Studies have shown that POCUS is feasible in the prehospital setting and does not significantly increase the scene or transport times of patients [ 12 – 15 ]. In the United States, only about 4% of EMS systems have implemented use of POCUS for patient evaluation [ 16 , 17 ]. However, some studies in the prehospital setting show that its use can change patient outcomes and management [ 3 , 18 ]. One study by Chin et al. demonstrated that paramedics could identify life-threatening conditions, such as tension pneumothorax and cardiac tamponade, using their prehospital assessment with ultrasound for emergencies (PAUSE) protocol [ 19 ]. In addition, prehospital ultrasound has been used to determine the proper placement of endotracheal tubes, detect long bone fractures, confirm intraosseous line placement, identify pulmonary edema, and assess cardiac activity in cardiac arrest [ 20 , 21 – 30 ]. Another possible benefit of prehospital POCUS is its potential to decrease time to diagnosis and to improve patient outcomes in trauma and critical illness. For example, a 2006 multicenter study found that combining physical examination with FAST examination significantly improved specificity and accuracy in determining intra-abdominal bleeding in trauma patients, and resulted in earlier CT scans and changes in patient management and destination hospitals [ 3 ]. The findings also showed that prehospital FAST examinations were carried out an average of 35 minutes sooner than ultrasounds were performed in the ED. A systematic review showed that the transport of patients to trauma centers, rather than non-trauma centers, led to a 15% reduction in mortality [ 19 ]. Taylor et al. found that 21% of EMS systems in the United States were considering implementing bedside ultrasonography [ 16 ]. Despite its potential benefits, a major barrier to implementing POCUS in the prehospital setting is the lack of efficient and structured training programs. Several studies have shown that paramedics and other prehospital providers can successfully perform the eFAST examination after a one-day, eight-hour course. [ 12 – 15 ]. Based on the potential for improved patient outcomes, it is essential that prehospital providers in the United States be trained in the use of POCUS, and in the efficient execution and interpretation of the eFAST [ 17 , 18 , 38 ]. Additionally, there is still a need for more research on the best approaches and effective training curricula in POCUS to meet the needs of EMS providers [ 39 , 40 ]. A needs analysis conducted with local EMS and air transport agencies revealed that a major barrier to the implementation of POCUS in the prehospital setting was a lack of efficient and structured training programs, consistent with findings in previous studies. This led to the development of a training curriculum in EMS POCUS with an initial course focused on POCUS fundamentals and the eFAST protocol. The goal of this study was to implement and evaluate the effectiveness of a simulation-based POCUS course for EMS professionals using the Kirkpatrick methodology for levels 1 (Reaction) and 2 (Learning). Methods Study Design & Setting: This was a single-group quasi-experimental (pretest-posttest) study design to evaluate the effectiveness of, and participant satisfaction with, the course. The study was conducted at the Gordon Center for Simulation & Innovation in Medical Education, University of Miami, Miller School of Medicine. Study reporting followed the STROBE checklist for observational studies (Supplement 1). Ethics Approval and Consent to Participate: The University of Miami Institutional Review Board approved this study (ID No.: 20170767) on 9/28/2017. Because the study involved evaluation of an educational intervention with aggregated, de-identified data, it qualified for an exemption and a waiver of informed consent. Participants: We conducted a power analysis for a paired samples t-test with 80% power for detecting a medium effect at alpha = .05. The results indicated a required sample size of at least 34. We obtained a sample size of 128, consisting almost entirely of practicing paramedics and flight nurses (including one physician working with EMS and two members of the United States Army medical division) from 32 EMS agencies. Most of the agencies were based in Florida although we also had participants from other states as some of the EMS POCUS courses were offered as part of EMS conferences. Participants were identified by their departmental leaders as integral to the agency’s existing or planned POCUS education program. We included 128 participants who participated in 11 courses between February 2017 and May 2024, and for whom we had complete data. Participants who did not complete the pre- or post-course assessment (incomplete data) were excluded. Curriculum Development: We developed and implemented a one-day (8-hour), in-person POCUS course consisting of didactic lectures, hands-on ultrasound scanning on standardized patients, simulation-based POCUS cases, a clinical case mini-workshop, and a content review. A needs assessment with participating EMS agencies, along with a review of the existing literature, and input from subject matter experts in POCUS, emergency medicine, EMS, and simulation-based healthcare education were used to determine the course content. In addition to incorporating the fundamentals of POCUS and image acquisition and interpretation, we focused on trauma POCUS using the eFAST protocol, as this had the greatest evidence for impact on patient care and outcomes in the prehospital setting. To allow adequate hands-on instruction and deliberate practice, we maintained an instructor-to-learner ratio of ≤ 1:5. Didactic Lectures and Hands-on Training : Prior to the course, participants were assigned e-learning modules on “Fundamentals of Ultrasound” and the “eFAST,” utilizing SonoSim ® Courses (Santa Monica, CA). The one-day course was held over eight hours and the agenda included 2.5 hours of lectures, 30 minutes of interactive cases, 3.5 hours of hands-on skills training, and 1 hour (30 minutes each) for pre-course and post-course assessments (Figure 1). Sessions covered the fundamentals of ultrasound and an introduction to the eFAST, including the views in six different anatomical regions (Figure 2). Examples of both normal and abnormal findings were presented. After each didactic session, the participants were separated into small groups for hands-on POCUS practice guided by faculty in emergency medicine, trauma, EMS, critical care nursing, and military surgical teams. All the faculty had extensive POCUS training either during their residency or as additional on-the-job training. The ultrasound devices primarily used in the skills stations included the Sonosite ® Edge and Sonosite ® SII (FUJIFILM Sonosite ® , Bothell, WA-USA). We also incorporated the portable devices [Butterfly iQ3 (Burlington MA-USA), Lumify (Phillips Ultrasound, Bothell WA-USA) Vscan Air™ (GE Healthcare Wauwatosa, WI-USA)] that participating EMS agencies planned to adopt. This allowed participants to practice and become familiar with the devices that would be used in the field, including knobology, anatomical relationships, and artifacts. The participants had several opportunities to acquire and interpret real-time ultrasound images of standardized patients with normal anatomy. Additionally, the participants were able to obtain and evaluate images showing pathology in all eFAST regions, utilizing the SonoSim LiveScan® platform (Santa Monica, CA-USA). The course incorporated ultrasound image artifacts, pearls, and pitfalls, and an interactive case discussion (30-minutes) that engaged the participants on clinical reasoning using real cases and POCUS video clips. The course culminated in an interactive review game (30-minutes) using Kahoot! platform (Oslo, Norway). eFAST Imaging : An eFAST examination included images in six anatomical locations: 1) right upper quadrant (RUQ) / Morrison’s Pouch; 2) subxiphoid and parasternal cardiac; 3) left upper quadrant (LUQ) / splenorenal; 4) suprapubic; and 5+6) the pleural interfaces (Figure 2). Curriculum Evaluation: Using the principles of Kirkpatrick's program evaluation, we evaluated the effectiveness of the curriculum for Level 1 (Reaction) and Level 2 (Learning). Level 1(Reaction): At the conclusion of the course, the participants completed an evaluation. Our study team developed the survey instrument, having experts in education research and program evaluation who further tested the instrument’s validity (Supplement 2). It included questions on the relevance and utility of the course in the participants’ current practice, achievement of learning objectives, the overall training environment, and faculty effectiveness. Responses were measured on a five-point Likert scale, with 1 indicating strong disagreement and 5 indicating strong agreement. Participants also provided open-ended feedback. Level 2 (Learning): The participants completed a pre-course assessment with 20 multiple-choice questions. This determined their baseline knowledge of POCUS and the eFAST examination. Immediately after the course, the participants completed a content-matched post-course assessment. The assessment items were developed by a team of expert faculty from emergency medicine, ultrasound, medical education, and EMS with experience ranging from 5 to 28 years. Both assessments addressed the course’s learning objectives, and they underwent validation through a rigorous process of development, item analysis, and piloting. The pre-and post-assessment items were the same for all the 11 courses offered. The instructors were blinded to the pre- and post-course assessment results during the course to prevent bias. Additionally, we conducted an item analysis of the pre-and post-course assessments of learners who took the course between 2023 and 2024, to compare their performance in six content areas:1) eFAST scan basics (including knobology, image capture, and view optimization); 2) right upper quadrant view; 3) subxiphoid view; 4) left upper quadrant view; 5) suprapubic/pelvic view; and 6) bilateral views of the pleural interface. Table 1. Learner Demographics Variable No. Learners 128 Median age (min, max) 39.0 (23, 63) Sex Male Female 98 (76.6%) 30 (23.4%) Profession Paramedics Registered Nurses Physician Other (Military) 103 (80.5%) 22 (17.2%) 1 (0.8%) 2 (1.6%) Data Analysis: Using IBM SPSS, v.29, the research team performed a paired samples t-test to compare pre- and post-assessment scores and calculated the effect size (Cohen’s d ). The pre-course assessment scores were compared, for any baseline differences across content areas, using analysis of variance (ANOVA). For course evaluation ratings, the mean Likert scale rating for each component was calculated. The satisfaction threshold for the course was set to >4 on a 5-point Likert scale before the implementation of the study, where 1 was the minimum and 5 was the maximum score for each statement. Data was analyzed by study team members trained in biostatistics. Results Participant Demographics: Table 1 displays the learner demographics, with a mean age of 39.0 years (range of 23-63 years). Approximately three-quarters (76.6%) of participants were male, and more than three-quarters (80.5%) were paramedics. Learner Performance: The mean score for the pre-course assessment was 67.6% (95% CI 64.7%-70.5%), and the mean for the post-course assessment was 89.0% (95% CI 87.3%-90.7%). The 21.4 percentage point increase (95% CI 18.9-23.9) was statistically significant, with a p-value of <0.001 (Figure 3) and a large effect size [Cohen’s d = 1.52]. An ANOVA for pre-course assessment revealed statistically significant differences. These were largely explained by a high mean score in the suprapubic view content area and a low mean score in the bilateral pleural interface content area (Table 2). All the content areas showed statistically significant pre-to-post improvements except for the suprapubic/pelvic view. (Table 2). Table 2: Summary of the item analysis of pre-and post-course assessments (each item carried a maximum score of 5) Content Area (n=122) Number of Items (20) Pre-test Mean ± SD; (Range max 5) Post-test Mean ± SD; (Range max 5) p-value Percent change (pre-post; %) Effect Size (Cohen's d ) 1. POCUS fundamentals (including knobology, image capture, and view optimization) 9 3.35 ± 0.96 (1.10, 5.0) 4.45 ± 0.50 (3.33,5.0) <.001 +33 1.09 2. Right upper quadrant view 2 3.03 ± 1.22 (0, 5.0) 4.39 ± 1.09 (2.50, 5.0) <.001 +45 0.84 3. Subxiphoid view 3 3.36 ± 1.43 (0, 5.0) 4.81 ± 0.54 (3.33, 5.0) <.001 +43 1.06 4. Left upper quadrant view 3 3.57 ± 1.48 (0, 5.0) 4.59 ± 0.73 (3.33, 5.0) <.001 +29 0.60 5. Supra pubic/pelvic view 2 4.30 ± 1.38 (0, 5.0) 4.67 ± 0.85 (2.50, 5.0) .072 +9 0.24 6. Bilateral views of the pleural interface 1 2.29 ± 2.51 (0, 5.0) 4.76 ± 1.25 (0, 5.0) <.001 +108 0.94 Course Evaluations: We received 122 course evaluations. Participants expressed nearly unanimous strong agreement on the course’s benefits (Table 3). Selected examples of the participants’ open-ended comments are listed in Table 4. Additionally, a thematic analysis of open-ended responses revealed the following topics: Course Quality and Content: Participants liked the course, and mentioned it made complex information easy to understand. Instructors and Teaching Methods: Participants praised the instructors for their knowledge and teaching style, which effectively combined lectures with hands-on skills practice. Hands-on Experience: Participants valued the practical (hands-on) component as they felt it improved their confidence and requested more such sessions in the future. Future Improvements: Suggestions included offering advanced courses, refresher sessions, and addressing technical issues (troubleshooting) using simulations. Table 3. Mean Rating, Course Evaluation Items (1 = “Strongly Disagree,” 5 = “Strongly Agree”) Course Evaluation Statement (n=122) Mean Rating Scale of 1-5 ± SD Course Content The program met the stated educational objectives. 4.9 ± 0.31 The content was appropriate for my level of education and training. 4.8 ± 0.44 The concepts I learned are applicable to my work role. 4.9 ± 0.38 I have gained knowledge that will improve patient care. 4.9 ± 0.28 Setting A positive learning environment was maintained during the course. 4.9 ± 0.23 There was adequate time for hands-on skills practice. 4.9 ± 0.46 The training facilities were conducive to learning. 4.9 ± 0.37 Instructional Methods The instructional methods were well-organized and clear. 4.9 ± 0.24 The length and pace of the course were appropriate. 4.9 ± 0.35 The course provided an adequate mixture of didactics and skills practice. 4.9 ± 0.23 Table 4. Examples of Learner Comments from Course Evaluations Excellent course. I learned so much. I had no experience in the past with ultrasound. Everyone was very informative and patient, ensuring we were finding our objectives. Great content, applicable, relevant, good mix and balance. Great course, as I became more confident with imaging interpretation for free fluid. Great course. Should be required for all EMS [providers]. Can improve patient treatment and outcomes. Great intro/practice for a skill I’ve never performed. I feel more comfortable performing it. Great course. Made difficult information easy to grasp. Instructors did a good job delivering the information. Instructors did an amazing job explaining and giving feedback during hands-on sessions. This [course] displays the way EMS is going towards the future for patient outcomes. This course provides additional knowledge that will assist in better assessments. Discussion Our study demonstrated the effectiveness of a one-day (8-hour) course format for teaching POCUS (eFAST) to EMS professionals. Learners found it relevant and useful for their success in learning the eFAST examination (Kirkpatrick Level 1 - Reaction). The results also show a significant improvement in learners’ knowledge (in post-course assessment) with the basics of eFAST, including knobology, image acquisition, and interpretation (Kirkpatrick Level 2 - Learning). Additionally, in open-text responses, several participants indicated that the course improved their comfort and confidence with using POCUS for eFAST. These findings support the use of an 8-hour course, coupled with pre-learning, as an effective method for teaching eFAST to EMS providers as a starting point to develop POCUS competency, coupled with clinical practice with feedback, and quality assurance. Although prehospital POCUS is infrequently used by EMS in the United States, interest and implementation are rising [ 9 , 16 ]. Some of the barriers to more universal implementation include resource allocation of funds for POCUS equipment, using the technology, equipment limitations, and structured training programs designed for the EMS provider [ 16 , 41 ]. Certainly, as the portability of ultrasound units has increased, and the cost has decreased, this is less of a concern. However, the lack of evidence and competency-based training remains a barrier, such as there is no quality assurance process or a way to do ongoing image review and improvement. Our study addresses one of these barriers by providing evidence for an effective training format. Prehospital providers can learn image acquisition and interpretation using a simulation-based course combining didactics and hands-on practice [ 12 – 14 ]. There is still a question, however, whether skills acquired in the simulation education setting translate to the clinical setting. To that point, Heegaard et al. showed that a six-hour course for paramedics on obtaining eFAST POCUS images correlated with their ability to perform the exam on live patients in the prehospital setting [ 4 ]. Several other studies in the simulation education literature have shown that skills learned in the simulation lab transfer to the clinical setting [ 31 – 34 ]. While our study did not directly assess the transfer of skills to the clinical environment, the significant improvement in learners' knowledge and confidence suggests that this training format could serve as a foundation for developing clinical competence for POCUS in EMS professionals when coupled with continued deliberate practice. This training approach addresses one of the key barriers to implementing prehospital POCUS by providing a structured, efficient learning format. In our courses, we used the portable POCUS devices that the EMS agencies were already using or considering using. This also helped the participants familiarize themselves with, and troubleshoot any issues, with their devices. This potentially addressed another challenge of using the technology and its limitations (such as battery time, glare from the screen, connectivity, and protection of the device while using it) [ 41 ]. Future research should focus on assessing the long-term retention of these skills and their translation to clinical practice demonstrating the impact of prehospital POCUS on patient morbidity and mortality. Our findings are likely generalizable to other EMS providers, as the sample included providers from diverse pre-hospital systems (e.g., HEMS, fire rescue, and military). This diversity in our study population strengthens the applicability of our findings to various prehospital settings. Additional deliberate practice along with quality assurance oversight is critical to the effectiveness of EMS POCUS. Newer ultrasound systems that incorporate guided image acquisition and artificial intelligence-based interpretation may be helpful as prehospital providers implement POCUS. Limitations While this study suggests that a single-day (8-hour) course is successful at teaching the fundamentals of ultrasound and the techniques necessary to obtain and interpret eFAST images correctly, it has some limitations. Our study used a quasi-experimental design, which lacked a control group due to logistical challenges related to the availability of learners, so the true causation of our curriculum resulting in their improved ability is not able to be proven. Perhaps in the future, a control group given open-access asynchronous ultrasound study material could be evaluated alongside our study cohort to determine the true efficacy of our curriculum. We used convenience sampling which suffers from a self-selection bias, meaning we may have recruited more motivated participants with different characteristics than the wider pool of prehospital providers. In the future, we could potentially expand our cohort to include all individuals in a particular prehospital system to try and reduce this self-selection bias. No blinding was implemented in our study since it was a single group pretest/posttest design. Our study was limited to the lower levels of Kirkptrick’s model and additional studies in the future should address higher learning levels; 3 (behavior) & 4 (impact). Finally, our study does not address skill retention among participants in the weeks to months following the course. Skill decay occurs if skills are not used regularly, and additional training may be needed. There is limited research about skill retention for EMS professionals participating in an ultrasound training course, requiring more research in this area. Conclusion This study demonstrates that a single-day (8-hour), simulation-based course can help teach ultrasound fundamentals and eFAST image interpretation techniques to EMS professionals. Further studies are necessary to determine if this type of course can lead to improved patient outcomes, and to what extent EMS professionals retain knowledge and skills in the weeks and months after participating in such a course. Understanding that a one-day program is not sufficient for mastery of this new skill, additional practice and a comprehensive oversight program with experienced POCUS clinicians was recommended to all participating EMS agencies. Moreover, future studies should examine if an expanded and ongoing training program, including proctored scanning time in the clinical setting and online teaching modules, can result in better learning outcomes and skill retention. List of Abbreviations Computed Tomography (CT) Emergency Medical Services (EMS) Extended focused assessment with sonography in trauma (eFAST) Focused Sonography in Trauma (FAST) Gordon Center for Simulation and Innovation in Medical Education (GCSIMEd) Helicopter Emergency Medical Services (HEMS) Inferior vena cava (IVC) International Business Machines (IBM) Left Upper Quadrant (LUQ) Point-of-care Ultrasound (POCUS) Prehospital Assessment with Ultrasound for Emergencies (PAUSE) Right Upper Quadrant (RUQ) United Kingdom (UK) Declarations Ethics Approval and Consent to Participate: The University of Miami Institutional Review Board approved this study (ID No.: 20170767). Because the study involved evaluation of an educational intervention with aggregated, de-identified data, it qualified for an exemption and a waiver of informed consent. The authors confirm that the study was conducted in accordance with the Helsinki Declaration Consent for Publication: Not applicable. Clinical Trail Number: Not applicable Availability of Data and Materials: The datasets analyzed for this study are available from the corresponding author upon reasonable request. Competing Interests: No author involved with this manuscript reports any competing interests. Funding: This research was self-funded by the University of Miami Michael S. Gordon Center for Simulation and Innovation in Medical Education (GCSIMEd). Authors & Individual Author Contributions: Author Contributions: Ariana Weber (AW)- acquisition of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content Asit Misra (AM) – Critical revision of the manuscript conducted data and item analysis, and development of the evaluation instrument. Richard D. Rodriguez (RDR) - study concept and design, analysis and interpretation of the data, critical revision of the manuscript for important intellectual content, statistical expertise. Angel “Al” Brotons (AAB) - acquisition of the data, critical revision of the manuscript for important intellectual content Maria Antonietta Mosetti (MAM) - acquisition of the data, critical revision of the manuscript for important intellectual content Resa E. Lewiss (REL) - study concept and design, acquisition of the data, critical revision of the manuscript for important intellectual content, study supervision Eduard Tiozzo (ET) - analysis of the data, critical revision of the manuscript for important intellectual content Ivette Motola (IM) - study concept and design, acquisition of the data, interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, study supervision Acknowledgements: The study team would like to thank all the EMS and air rescue personnel who participated in the training. 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The feasibility of using ultrasound and video laryngoscopy in a mobile telemedicine consult. Telemed J E Health. 2008;14:266–72. 10.1016/j.resuscitation.2011.11.010 . Heiner JD, McArthur TJ. The ultrasound identification of simulated long bone fractures by prehospital providers. Wilderness Environ Med. 2010;21:137–40. 10.1016/j.wem.2009.12.028 . McNeil CR, McManus J, Mehta S. The accuracy of portable ultrasonography to diagnose fractures in an austere environment. Prehosp Emerg Care. 2009;13:50–2. 10.1080/10903120802474513 . Tsung JW, Blaivas M, Stone MB. Feasibility of point-of-care color Doppler ultrasound confirmation of intraosseous needle placement during resuscitation. Resuscitation. 2009;80:665–8. 10.1016/j.resuscitation.2009.03.009 . Noble VE, Lamhaut L, Capp R, Bosson N, Liteplo A, Marx JS, Carli P. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Educ. 2009;9:3–10. 10.1186/1472-6920-9-3 . Zechner PM, Aichinger G, Rigaud M, Wildner G, Prause G. Prehospital lung ultrasound in the distinction between pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Am J Emerg Med. 2010;28:e3891–2. 10.1016/j.ajem.2009.07.021 . Aichinger G, Zechner PM, Prause G, et al. Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients. Prehosp Emerg Care. 2012;16:251–5. 10.3109/10903127.2011.640414 . Barsuk JH, Cohen ER, Caprio T, McGaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology. 2012;79:132–7. 10.1212/wnl.0b013e31825dd39d . Birnbach DJ, Salas E. Can medical simulation and team training reduce errors in labor and delivery? Anesthesiol Clin. 2008;26:159 – 68, viii. 10.1016/j.anclin.2007.11.001 Scherer YK, Bruce SA, Graves BT, Erdley WS. Acute care nurse practitioner education: enhancing performance through the use of clinical simulation. AACN Clin Issues. 2003;14:331–41. 10.1097/00044067-200308000-00008 . Zendejas B, Cook DA, Bingener J, Huebner M, Dunn WF, Sarr MG, Farley DR. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg. 2011;254:502–9. 10.1097/sla.0b013e31822c6994 . discussion 509 – 11. van den Hout WJ, van der Wilden GM, Boot F, Idenburg FJ, Rhemrev SJ, Hoencamp R. Early CT scanning in the emergency department in patients with penetrating injuries: does it affect outcome? Eur J Trauma Emerg Surg. 2018;44:607–14. 10.1007/s00068-017-0831-5 . Çorbacıoğlu ŞK, Aksel G. Whole body computed tomography in multi trauma patients: review of the current literature. Turk J Emerg Med. 2018;18:142–7. 10.1016/j.tjem.2018.09.003 . Imai S, Akahane M, Konishi Y, Imamura T. Benefits of computed tomography in reducing mortality in emergency medicine. Open Med (Wars). 2018;13:394–401. 10.1515/med-2018-0058 . Jonck C, Weimer AM, Fundel B, Heinz W, Merkel D, Fiedel H, et al. Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany – a prospective observational study and comparison. BMC Med Educ. 2024;24(1):811. Vianen NJ, Van Lieshout EMM, Vlasveld KHA, Maissan IM, Gerritsen PC, Den Hartog D, Verhofstad MHJ, Van Vledder MG. Impact of Point-of-Care Ultrasound on Prehospital Decision Making by HEMS Physicians in Critically Ill and Injured Patients: A Prospective Cohort Study. Prehosp Disaster Med. 2023;38(4):444–9. 10.1017/S1049023X23006003 . Jonck C, Weimer AM, Fundel B, et al. Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany – a prospective observational study and comparison. BMC Med Educ. 2024;24:811. https://doi.org/10.1186/s12909-024-05816-1 . Amaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med. 2020;8:2050312120932706. 10.1177/2050312120932706 . Additional Declarations No competing interests reported. Supplementary Files Supplement1STROBEChecklist.pdf Supplement2EMSPOCUSCourseEvaluationQuestionnaire.pdf Cite Share Download PDF Status: Published Journal Publication published 21 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 26 May, 2025 Reviewers agreed at journal 06 Apr, 2025 Reviews received at journal 25 Mar, 2025 Reviewers agreed at journal 25 Mar, 2025 Reviewers invited by journal 25 Mar, 2025 Submission checks completed at journal 25 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5831070","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":433986549,"identity":"291f32e4-377c-4fa9-9f8b-d886d797c2f4","order_by":0,"name":"Ariana Weber","email":"","orcid":"","institution":"Boston Medical Center Department of Emergency Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ariana","middleName":"","lastName":"Weber","suffix":""},{"id":433986550,"identity":"eb6ebbcd-3bee-4f33-ae8f-3530226244d8","order_by":1,"name":"Asit Misra","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYFACxgYgIQHEzAcYGNjAiAHIYsanpbEBooUtgVgtEGuAgMcAoh4CcGvh7z/c/oAxx8LevP3M1w0fyhii+dhPJx5gqLBObMChReJGYmMD4zaJxDlncrfdnHGOIbeNJ3fDAYYz6Ti1MNxgBGtJkGDI3Xabtw2ohQGohbHtME4t8ucPgrXYS/C/eXb7L0gL/1ugln+4tRgcgDiMcYZEDtttRpAWCZAtDbi1GAL9MiMR6JcZEs/MbvackwBqAdqScCzdGJcWufPHH3z4uK0O6LDkZzd+lNnkzu/P3fzhQ421LE7vg0ACgimBITIKRsEoGAWjgAwAAD9MYJgpdlOYAAAAAElFTkSuQmCC","orcid":"","institution":"Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Asit","middleName":"","lastName":"Misra","suffix":""},{"id":433986551,"identity":"bbf6a18a-138c-48da-af36-cc3efcf93233","order_by":2,"name":"Richard D. Rodriguez","email":"","orcid":"","institution":"Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"D.","lastName":"Rodriguez","suffix":""},{"id":433986552,"identity":"8c68df0a-0043-49c0-996f-abbc289b7145","order_by":3,"name":"Angel “Al” Brotons","email":"","orcid":"","institution":"Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Angel","middleName":"“Al”","lastName":"Brotons","suffix":""},{"id":433986553,"identity":"c29cc7ce-fbf8-480a-8a7e-a1e4d50b011d","order_by":4,"name":"Maria Antonietta Mosetti","email":"","orcid":"","institution":"Department of Medicine, Division of Hospital Medicine, University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Antonietta","lastName":"Mosetti","suffix":""},{"id":433986554,"identity":"1cc639a1-f7f2-49ee-a3ec-540a7cfd8894","order_by":5,"name":"Resa E. Lewiss","email":"","orcid":"","institution":"Department of Emergency Medicine, University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Resa","middleName":"E.","lastName":"Lewiss","suffix":""},{"id":433986555,"identity":"428a682a-40b4-4be5-bcc3-db8159e837dd","order_by":6,"name":"Eduard Tiozzo","email":"","orcid":"","institution":"Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Eduard","middleName":"","lastName":"Tiozzo","suffix":""},{"id":433986556,"identity":"9f604215-f631-4628-9f0e-8cccaeb50b27","order_by":7,"name":"Ivette Motola","email":"","orcid":"","institution":"Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ivette","middleName":"","lastName":"Motola","suffix":""}],"badges":[],"createdAt":"2025-01-15 04:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5831070/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5831070/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07675-w","type":"published","date":"2025-07-21T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79614470,"identity":"6b3421e2-52d0-4a99-9979-fd007a24f8ad","added_by":"auto","created_at":"2025-03-31 18:49:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":351333,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCourse Overview Slide. This slide reviews the components of the 8-hour course. The course includes didactic sessions, hands-on skills practice sessions, and a review game prior to the post-course assessment.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5831070/v1/5be075c8934219466ee38b17.png"},{"id":79614920,"identity":"6f7bc753-8bef-48b2-b0b9-ab06d49d1d7d","added_by":"auto","created_at":"2025-03-31 18:57:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":328305,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eAn eFAST\u003c/em\u003e (\u003cem\u003eExtended focused assessment with sonography in trauma examination) includes six anatomical \u003c/em\u003eregions\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5831070/v1/6d312ebe10870d7aafaadfcc.png"},{"id":79613949,"identity":"fe3f38a8-c792-47c9-a0b5-221594784c9b","added_by":"auto","created_at":"2025-03-31 18:41:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":12525,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePre- and Post-course Mean Knowledge Assessment Scores (%)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5831070/v1/f7886a65e4a61a1d79afbd6e.png"},{"id":87757320,"identity":"19e48d0d-bcbf-476f-b218-5c0aeb695a7f","added_by":"auto","created_at":"2025-07-28 16:10:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1688453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5831070/v1/4dac3e48-2d85-4795-b1c5-63c28e98bc45.pdf"},{"id":79613957,"identity":"599da798-6e1c-4f97-9918-e28c784cc503","added_by":"auto","created_at":"2025-03-31 18:41:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":89287,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1STROBEChecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5831070/v1/fad6c62a4f3b22bdc1dc2980.pdf"},{"id":79613962,"identity":"4678de7e-3eac-4ca0-8d42-1491cfcc9795","added_by":"auto","created_at":"2025-03-31 18:41:41","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":344779,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement2EMSPOCUSCourseEvaluationQuestionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5831070/v1/8da51aa8bb07aae8ccf92e1a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of a Simulation-based Point-of-care Ultrasound Course for Prehospital Providers - A Single Group Quasi-Experimental Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePoint-of-care ultrasound (POCUS) is integral to the assessment and evaluation of critically ill patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The technology allows clinicians to quickly and efficiently identify intra-abdominal and intra-thoracic injuries, including those from blunt or penetrating trauma. The Extended Focused Assessment with Sonography in Trauma (eFAST) has become a gold standard for early screening in trauma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. An experienced operator can perform an eFAST in under three minutes with approximately 93% sensitivity and 99% specificity for detecting free fluid in the abdomen and/or pericardial space [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of POCUS by emergency medical services (EMS) has been extensively studied in United Kingdom, Germany, France, and Italy [\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In these countries physicians often spend more time on the scene, evaluating and treating patients using POCUS as an adjunct for triage, patient assessment, and management in the field [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Studies have shown that POCUS is feasible in the prehospital setting and does not significantly increase the scene or transport times of patients [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the United States, only about 4% of EMS systems have implemented use of POCUS for patient evaluation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, some studies in the prehospital setting show that its use can change patient outcomes and management [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. One study by Chin \u003cem\u003eet al.\u003c/em\u003e demonstrated that paramedics could identify life-threatening conditions, such as tension pneumothorax and cardiac tamponade, using their prehospital assessment with ultrasound for emergencies (PAUSE) protocol [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, prehospital ultrasound has been used to determine the proper placement of endotracheal tubes, detect long bone fractures, confirm intraosseous line placement, identify pulmonary edema, and assess cardiac activity in cardiac arrest [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother possible benefit of prehospital POCUS is its potential to decrease time to diagnosis and to improve patient outcomes in trauma and critical illness. For example, a 2006 multicenter study found that combining physical examination with FAST examination significantly improved specificity and accuracy in determining intra-abdominal bleeding in trauma patients, and resulted in earlier CT scans and changes in patient management and destination hospitals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The findings also showed that prehospital FAST examinations were carried out an average of 35 minutes sooner than ultrasounds were performed in the ED.\u003c/p\u003e \u003cp\u003eA systematic review showed that the transport of patients to trauma centers, rather than non-trauma centers, led to a 15% reduction in mortality [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Taylor \u003cem\u003eet al.\u003c/em\u003e found that 21% of EMS systems in the United States were considering implementing bedside ultrasonography [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite its potential benefits, a major barrier to implementing POCUS in the prehospital setting is the lack of efficient and structured training programs. Several studies have shown that paramedics and other prehospital providers can successfully perform the eFAST examination after a one-day, eight-hour course. [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Based on the potential for improved patient outcomes, it is essential that prehospital providers in the United States be trained in the use of POCUS, and in the efficient execution and interpretation of the eFAST [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, there is still a need for more research on the best approaches and effective training curricula in POCUS to meet the needs of EMS providers [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA needs analysis conducted with local EMS and air transport agencies revealed that a major barrier to the implementation of POCUS in the prehospital setting was a lack of efficient and structured training programs, consistent with findings in previous studies. This led to the development of a training curriculum in EMS POCUS with an initial course focused on POCUS fundamentals and the eFAST protocol. The goal of this study was to implement and evaluate the effectiveness of a simulation-based POCUS course for EMS professionals using the Kirkpatrick methodology for levels 1 (Reaction) and 2 (Learning).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Design \u0026amp; Setting:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eThis was a single-group quasi-experimental (pretest-posttest) study design to evaluate the effectiveness of, and participant satisfaction with, the course.\u0026nbsp;The study was conducted at the Gordon Center for Simulation \u0026amp; Innovation in Medical Education, University of Miami, Miller School of Medicine. Study reporting followed the STROBE checklist for observational studies (Supplement 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent to Participate:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe University of Miami Institutional Review Board approved this study (ID No.: 20170767) on 9/28/2017. Because the study involved evaluation of an educational intervention with aggregated, de-identified data, it qualified for an exemption and a waiver of informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants:\u003c/em\u003e\u003c/strong\u003e We conducted a power analysis for a paired samples t-test with 80% power for detecting a medium effect at alpha = .05. The results indicated a required sample size of at least 34. We obtained a sample size of 128, consisting almost entirely of practicing paramedics and flight nurses (including one physician working with EMS and two members of the United States Army medical division) from 32 EMS agencies. Most of the agencies were based in Florida although we also had participants from other states as some of the EMS POCUS courses were offered as part of EMS conferences. Participants were identified by their departmental leaders as integral to the agency\u0026rsquo;s existing or planned POCUS education program. We included 128 participants who participated in 11 courses between February 2017 and May 2024, and for whom we had complete data. Participants who did not complete the pre- or post-course assessment (incomplete data) were excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCurriculum Development:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eWe developed and implemented a\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eone-day (8-hour), in-person POCUS course consisting of didactic lectures, hands-on ultrasound scanning on standardized patients, simulation-based POCUS cases, a clinical case mini-workshop, and a content review. A needs assessment with participating EMS agencies, along with a review of the existing literature, and input from subject matter experts in POCUS, emergency medicine, EMS, and simulation-based healthcare education were used to determine the course content. In addition to incorporating the fundamentals of POCUS and image acquisition and interpretation, we focused on trauma POCUS using the eFAST protocol, as this had the greatest evidence for impact on patient care and outcomes in the prehospital setting. To allow adequate hands-on instruction and deliberate practice, we maintained an instructor-to-learner ratio of \u0026le; 1:5.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDidactic Lectures and Hands-on Training\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003ePrior to the course, participants were assigned e-learning modules on \u0026ldquo;Fundamentals of Ultrasound\u0026rdquo; and the \u0026ldquo;eFAST,\u0026rdquo; utilizing SonoSim\u003csup\u003e\u0026reg;\u003c/sup\u003e Courses (Santa Monica, CA). The one-day course was held over eight hours and the agenda included 2.5 hours of lectures, 30 minutes of interactive cases, 3.5 hours of hands-on skills training, and 1 hour (30 minutes each) for pre-course and post-course assessments (Figure 1). Sessions covered the fundamentals of ultrasound and an introduction to the eFAST, including the views in six different anatomical regions (Figure 2). Examples of both normal and abnormal findings were presented.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter each didactic session, the participants were separated into small groups for hands-on POCUS practice guided by faculty in emergency medicine, trauma, EMS, critical care nursing, and military surgical teams. All the faculty had extensive POCUS training either during their residency or as additional on-the-job training. The ultrasound devices primarily used in the skills stations included the Sonosite\u003csup\u003e\u0026reg;\u003c/sup\u003e Edge and Sonosite\u003csup\u003e\u0026reg;\u003c/sup\u003e SII (FUJIFILM Sonosite\u003csup\u003e\u0026reg;\u003c/sup\u003e, Bothell, WA-USA). We also incorporated the portable devices [Butterfly iQ3 (Burlington MA-USA), Lumify (Phillips Ultrasound,\u0026nbsp;Bothell WA-USA) Vscan Air\u0026trade; (GE Healthcare Wauwatosa, WI-USA)] that participating EMS agencies planned to adopt. This allowed participants to practice and become familiar with the devices that would be used in the field, including knobology, anatomical relationships, and artifacts. The participants had several opportunities to acquire and interpret real-time ultrasound images of standardized patients with normal anatomy. Additionally, the participants were able to obtain and evaluate images showing pathology in all eFAST regions, utilizing the SonoSim LiveScan\u0026reg; platform (Santa Monica, CA-USA).\u003c/p\u003e\n\u003cp\u003eThe course incorporated ultrasound image artifacts, pearls, and pitfalls, and an interactive case discussion (30-minutes) that engaged the participants on clinical reasoning using real cases and POCUS video clips. The course culminated in an interactive review game (30-minutes) using Kahoot! platform (Oslo, Norway).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eeFAST Imaging\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e An eFAST examination included images in six anatomical locations: 1) right upper quadrant (RUQ) / Morrison\u0026rsquo;s Pouch; 2) subxiphoid and parasternal cardiac; 3) left upper quadrant (LUQ) / splenorenal; 4) suprapubic; and 5+6) the pleural interfaces (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCurriculum Evaluation:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eUsing the principles of Kirkpatrick\u0026apos;s program evaluation, we evaluated the effectiveness of the curriculum for Level 1 (Reaction) and Level 2 (Learning).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevel 1(Reaction):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eAt the conclusion of the course, the participants completed an evaluation. Our study team developed the survey instrument, having experts in education research and program evaluation who further tested the instrument\u0026rsquo;s validity (Supplement 2). It included questions on the relevance and utility of the course in the participants\u0026rsquo; current practice, achievement of learning objectives, the overall training environment, and faculty effectiveness. Responses were measured on a five-point Likert scale, with 1 indicating strong disagreement and 5 indicating strong agreement. Participants also provided open-ended feedback.\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevel 2 (Learning):\u003c/em\u003e\u0026nbsp;\u003c/strong\u003eThe participants completed a pre-course assessment with 20 multiple-choice questions. This determined their baseline knowledge of POCUS and the eFAST examination. \u0026nbsp;Immediately after the course, the participants completed a content-matched post-course assessment. The assessment items were developed by a team of expert faculty from emergency medicine, ultrasound, medical education, and EMS with experience ranging from 5 to 28 years. \u0026nbsp;Both assessments addressed the course\u0026rsquo;s learning objectives, and they underwent validation through a rigorous process of development, item analysis, and piloting. The pre-and post-assessment items were the same for all the 11 courses offered. The instructors were blinded to the pre- and post-course assessment results during the course to prevent bias. Additionally, we conducted an item analysis of the pre-and post-course assessments of learners who took the course between 2023 and 2024, to compare their performance in six content areas:1) eFAST scan basics (including knobology, image capture, and view optimization); 2) right upper quadrant view; 3) subxiphoid view; 4) left upper quadrant view; 5) suprapubic/pelvic view; and 6) bilateral views of the pleural interface.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1. Learner Demographics\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eNo. Learners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eMedian age (min, max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e39.0 (23, 63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;98 (76.6%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;30 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003cp\u003eParamedics\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRegistered Nurses\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePhysician\u003c/p\u003e\n \u003cp\u003eOther (Military)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e103 (80.5%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;22 (17.2%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1 (0.8%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Analysis:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eUsing IBM SPSS, v.29, the research team performed a paired samples t-test to compare pre- and post-assessment scores and calculated the effect size (Cohen\u0026rsquo;s\u003cem\u003e\u0026nbsp;d\u003c/em\u003e). The pre-course assessment scores were compared, for any baseline differences across content areas, using analysis of variance (ANOVA). For course evaluation ratings, the mean Likert scale rating for each component was calculated. The satisfaction threshold for the course was set to \u0026gt;4 on a 5-point Likert scale before the implementation of the study, where 1 was the minimum and 5 was the maximum score for each statement. \u0026nbsp;Data was analyzed by study team members trained in biostatistics.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipant Demographics:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eTable 1 displays the learner demographics, with a mean age of 39.0 years (range of 23-63 years). Approximately three-quarters (76.6%) of participants were male, and more than three-quarters (80.5%) were paramedics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLearner Performance:\u003c/em\u003e\u003c/strong\u003e The mean score for the pre-course assessment was 67.6% (95% CI 64.7%-70.5%), and the mean for the post-course assessment was 89.0% (95% CI 87.3%-90.7%). The 21.4 percentage point increase (95% CI 18.9-23.9) was statistically significant, with a p-value of \u0026lt;0.001 (Figure 3) and a large effect size [Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e = 1.52]. An ANOVA for pre-course assessment revealed statistically significant differences. These were largely explained by a high mean score in the suprapubic view content area and a low mean score in the bilateral pleural interface content area (Table 2). All the content areas showed statistically significant pre-to-post improvements except for the suprapubic/pelvic view. (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 2: Summary of the item analysis of pre-and post-course assessments (each item carried a maximum score of 5)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"654\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent Area\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=122)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Items (20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test Mean \u0026plusmn; SD;\u0026nbsp;(Range max 5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test Mean \u0026plusmn; SD;\u0026nbsp;(Range max 5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent change\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(pre-post; %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Cohen\u0026apos;s \u003cem\u003ed\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1. POCUS fundamentals (including knobology, image capture, and view optimization)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.35 \u0026plusmn; 0.96 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(1.10, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.45 \u0026plusmn; 0.50\u003c/p\u003e\n \u003cp\u003e(3.33,5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e+33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2. Right upper quadrant view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.03 \u0026plusmn; 1.22\u003c/p\u003e\n \u003cp\u003e(0, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.39 \u0026plusmn; 1.09\u003c/p\u003e\n \u003cp\u003e(2.50, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e+45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e3. Subxiphoid view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.36 \u0026plusmn; 1.43\u003c/p\u003e\n \u003cp\u003e(0, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.81 \u0026plusmn; 0.54\u003c/p\u003e\n \u003cp\u003e(3.33, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e+43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e4. Left upper quadrant view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.57 \u0026plusmn; 1.48\u003c/p\u003e\n \u003cp\u003e(0, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.59 \u0026plusmn; 0.73\u003c/p\u003e\n \u003cp\u003e(3.33, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e+29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e5. Supra pubic/pelvic view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.30 \u0026plusmn; 1.38\u003c/p\u003e\n \u003cp\u003e(0, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.67 \u0026plusmn; 0.85\u003c/p\u003e\n \u003cp\u003e(2.50, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e+9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e6. Bilateral views of the pleural interface\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.29 \u0026plusmn; 2.51\u003c/p\u003e\n \u003cp\u003e(0, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.76 \u0026plusmn; 1.25\u0026nbsp;(0, 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e+108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCourse Evaluations:\u003c/em\u003e\u003c/strong\u003e We received 122 course evaluations. \u0026nbsp;Participants expressed nearly unanimous strong agreement on the course\u0026rsquo;s benefits (Table 3). Selected examples of the participants\u0026rsquo; open-ended comments are listed in Table 4. Additionally, a thematic analysis of open-ended responses revealed the following topics:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eCourse Quality and Content:\u003c/strong\u003e Participants liked the course, and mentioned it made complex information easy to understand.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInstructors and Teaching Methods:\u0026nbsp;\u003c/strong\u003eParticipants praised the instructors for their knowledge and teaching style, which effectively combined lectures with hands-on skills practice.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHands-on Experience:\u003c/strong\u003e Participants valued the practical (hands-on) component as they felt it improved their confidence and requested more such sessions in the future.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFuture Improvements:\u003c/strong\u003e Suggestions included offering advanced courses, refresher sessions, and addressing technical issues (troubleshooting) using simulations.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eTable 3. Mean Rating, Course Evaluation Items (1 = \u0026ldquo;Strongly Disagree,\u0026rdquo; 5 = \u0026ldquo;Strongly Agree\u0026rdquo;)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCourse Evaluation Statement (n=122)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e \u003cstrong\u003eRating\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScale of 1-5\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCourse Content\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe program met the stated educational objectives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe content was appropriate for my level of education and training.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.8 \u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe concepts I learned are applicable to my work role.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eI have gained knowledge that will improve patient care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSetting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eA positive learning environment was maintained during the course.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThere was adequate time for hands-on skills practice.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe training facilities were conducive to learning.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eInstructional Methods\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe instructional methods were well-organized and clear.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe length and pace of the course were appropriate.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003eThe course provided an adequate mixture of didactics and skills practice.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003c/em\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 4. Examples of Learner Comments from Course Evaluations\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eExcellent course. I learned so much. I had no experience in the past with ultrasound.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eEveryone was very informative and patient, ensuring we were finding our objectives.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eGreat content, applicable, relevant, good mix and balance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eGreat course, as I became more confident with imaging interpretation for free fluid.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eGreat course. Should be required for all EMS [providers]. Can improve patient treatment and outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eGreat intro/practice for a skill I\u0026rsquo;ve never performed. I feel more comfortable performing it.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eGreat course. Made difficult information easy to grasp.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eInstructors did a good job delivering the information.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eInstructors did an amazing job explaining and giving feedback during hands-on sessions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eThis [course] displays the way EMS is going towards the future for patient outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eThis course provides additional knowledge that will assist in better assessments.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study demonstrated the effectiveness of a one-day (8-hour) course format for teaching POCUS (eFAST) to EMS professionals. Learners found it relevant and useful for their success in learning the eFAST examination (Kirkpatrick Level 1 - Reaction). The results also show a significant improvement in learners\u0026rsquo; knowledge (in post-course assessment) with the basics of eFAST, including knobology, image acquisition, and interpretation (Kirkpatrick Level 2 - Learning). Additionally, in open-text responses, several participants indicated that the course improved their comfort and confidence with using POCUS for eFAST. These findings support the use of an 8-hour course, coupled with pre-learning, as an effective method for teaching eFAST to EMS providers as a starting point to develop POCUS competency, coupled with clinical practice with feedback, and quality assurance.\u003c/p\u003e\u003cp\u003eAlthough prehospital POCUS is infrequently used by EMS in the United States, interest and implementation are rising [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Some of the barriers to more universal implementation include resource allocation of funds for POCUS equipment, using the technology, equipment limitations, and structured training programs designed for the EMS provider [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Certainly, as the portability of ultrasound units has increased, and the cost has decreased, this is less of a concern. However, the lack of evidence and competency-based training remains a barrier, such as there is no quality assurance process or a way to do ongoing image review and improvement. Our study addresses one of these barriers by providing evidence for an effective training format.\u003c/p\u003e\u003cp\u003ePrehospital providers can learn image acquisition and interpretation using a simulation-based course combining didactics and hands-on practice [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. There is still a question, however, whether skills acquired in the simulation education setting translate to the clinical setting. To that point, Heegaard \u003cem\u003eet al.\u003c/em\u003e showed that a six-hour course for paramedics on obtaining eFAST POCUS images correlated with their ability to perform the exam on live patients in the prehospital setting [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Several other studies in the simulation education literature have shown that skills learned in the simulation lab transfer to the clinical setting [\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. While our study did not directly assess the transfer of skills to the clinical environment, the significant improvement in learners' knowledge and confidence suggests that this training format could serve as a foundation for developing clinical competence for POCUS in EMS professionals when coupled with continued deliberate practice. This training approach addresses one of the key barriers to implementing prehospital POCUS by providing a structured, efficient learning format. In our courses, we used the portable POCUS devices that the EMS agencies were already using or considering using. This also helped the participants familiarize themselves with, and troubleshoot any issues, with their devices. This potentially addressed another challenge of using the technology and its limitations (such as battery time, glare from the screen, connectivity, and protection of the device while using it) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Future research should focus on assessing the long-term retention of these skills and their translation to clinical practice demonstrating the impact of prehospital POCUS on patient morbidity and mortality.\u003c/p\u003e\u003cp\u003eOur findings are likely generalizable to other EMS providers, as the sample included providers from diverse pre-hospital systems (e.g., HEMS, fire rescue, and military). This diversity in our study population strengthens the applicability of our findings to various prehospital settings. Additional deliberate practice along with quality assurance oversight is critical to the effectiveness of EMS POCUS. Newer ultrasound systems that incorporate guided image acquisition and artificial intelligence-based interpretation may be helpful as prehospital providers implement POCUS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile this study suggests that a single-day (8-hour) course is successful at teaching the fundamentals of ultrasound and the techniques necessary to obtain and interpret eFAST images correctly, it has some limitations. Our study used a quasi-experimental design, which lacked a control group due to logistical challenges related to the availability of learners, so the true causation of our curriculum resulting in their improved ability is not able to be proven. Perhaps in the future, a control group given open-access asynchronous ultrasound study material could be evaluated alongside our study cohort to determine the true efficacy of our curriculum. We used convenience sampling which suffers from a self-selection bias, meaning we may have recruited more motivated participants with different characteristics than the wider pool of prehospital providers. In the future, we could potentially expand our cohort to include all individuals in a particular prehospital system to try and reduce this self-selection bias. No blinding was implemented in our study since it was a single group pretest/posttest design. Our study was limited to the lower levels of Kirkptrick\u0026rsquo;s model and additional studies in the future should address higher learning levels; 3 (behavior) \u0026amp; 4 (impact). Finally, our study does not address skill retention among participants in the weeks to months following the course. Skill decay occurs if skills are not used regularly, and additional training may be needed. There is limited research about skill retention for EMS professionals participating in an ultrasound training course, requiring more research in this area.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that a single-day (8-hour), simulation-based course can help teach ultrasound fundamentals and eFAST image interpretation techniques to EMS professionals. Further studies are necessary to determine if this type of course can lead to improved patient outcomes, and to what extent EMS professionals retain knowledge and skills in the weeks and months after participating in such a course. Understanding that a one-day program is not sufficient for mastery of this new skill, additional practice and a comprehensive oversight program with experienced POCUS clinicians was recommended to all participating EMS agencies. Moreover, future studies should examine if an expanded and ongoing training program, including proctored scanning time in the clinical setting and online teaching modules, can result in better learning outcomes and skill retention.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eComputed Tomography (CT)\u003c/p\u003e\u003cp\u003eEmergency Medical Services (EMS)\u003c/p\u003e\u003cp\u003eExtended focused assessment with sonography in trauma (eFAST)\u003c/p\u003e\u003cp\u003eFocused Sonography in Trauma (FAST)\u003c/p\u003e\u003cp\u003eGordon Center for Simulation and Innovation in Medical Education (GCSIMEd)\u003c/p\u003e\u003cp\u003eHelicopter Emergency Medical Services (HEMS)\u003c/p\u003e\u003cp\u003eInferior vena cava (IVC)\u003c/p\u003e\u003cp\u003eInternational Business Machines (IBM)\u003c/p\u003e\u003cp\u003eLeft Upper Quadrant (LUQ)\u003c/p\u003e\u003cp\u003ePoint-of-care Ultrasound (POCUS)\u003c/p\u003e\u003cp\u003ePrehospital Assessment with Ultrasound for Emergencies (PAUSE)\u003c/p\u003e\u003cp\u003eRight Upper Quadrant (RUQ)\u003c/p\u003e\u003cp\u003eUnited Kingdom (UK)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent to Participate:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe University of Miami Institutional Review Board approved this study (ID No.: 20170767). Because the study involved evaluation of an educational intervention with aggregated, de-identified data, it qualified for an exemption and a waiver of informed consent. The authors confirm that the study was conducted in accordance with the Helsinki Declaration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for Publication:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical Trail Number:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe datasets analyzed for this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo author involved with this manuscript reports any competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was self-funded by the University of Miami Michael S. Gordon Center for Simulation and Innovation in Medical Education (GCSIMEd).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors \u0026amp; Individual Author Contributions:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor Contributions:\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eAriana Weber (AW)- acquisition of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAsit Misra (AM) – Critical revision of the manuscript conducted data and item analysis, and development of the evaluation instrument.\u003c/li\u003e\n \u003cli\u003eRichard D. Rodriguez (RDR) - study concept and design, analysis and interpretation of the data, critical revision of the manuscript for important intellectual content, statistical expertise.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAngel “Al” Brotons (AAB) - acquisition of the data, critical revision of the manuscript for important intellectual content\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMaria Antonietta Mosetti (MAM) - acquisition of the data, critical revision of the manuscript for important intellectual content\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eResa E. Lewiss (REL) - study concept and design, acquisition of the data, critical revision of the manuscript for important intellectual content, study supervision\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEduard Tiozzo (ET) - analysis of the data, critical revision of the manuscript for important intellectual content\u003c/li\u003e\n \u003cli\u003eIvette Motola (IM) - study concept and design, acquisition of the data, interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, study supervision\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study team would like to thank all the EMS and air rescue personnel who participated in the training. We would also like to acknowledge the Ultrasound Division faculty and residents of the University of Miami/Jackson Memorial Hospital Emergency Medicine Residency for their time and guidance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSnaith B, Hardy M, Walker A. Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes. Emerg Med J. 2011;28:1063\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/emj.2010.096966\u003c/span\u003e\u003cspan address=\"10.1136/emj.2010.096966\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTazarourte K, Dekadjevi H, Desmettre T, Tourtier JP, Trueba F, Schiano P. Focused assessment with sonography in trauma prehospital triage: an important tool. 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Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany \u0026ndash; a prospective observational study and comparison. BMC Med Educ. 2024;24:811. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12909-024-05816-1\u003c/span\u003e\u003cspan address=\"10.1186/s12909-024-05816-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med. 2020;8:2050312120932706. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2050312120932706\u003c/span\u003e\u003cspan address=\"10.1177/2050312120932706\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Point-of-care ultrasound, POCUS, Simulation, Medical education, Prehospital ultrasound, EMS education, Extended Focused Assessment with Sonography for Trauma, Air rescue","lastPublishedDoi":"10.21203/rs.3.rs-5831070/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5831070/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eEmergency medical service (EMS) professionals are increasingly using point-of-care ultrasound (POCUS) into the prehospital management and triage of critically ill patients. However, few institutions offer organized POCUS training for this community. Our goal was to offer and evaluate the effectiveness of a simulation-based POCUS course for EMS professionals.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe developed and implemented an eight-hour course to train EMS providers in the fundamentals of POCUS for blunt trauma patients. The course design included lectures, standardized patients hands-on scanning, simulation-based ultrasound cases, clinical cases based on real patients, and an end-of-course review game. Before the day of the course, participants were assigned e-learning modules on the fundamentals of POCUS and on the Extended Focused Assessment with Sonography for Trauma Exam (eFAST). The effectiveness of the course was evaluated using Kirkpatrick\u0026rsquo;s methodology for Level 1 (course evaluation by participants) and Level 2 (pre- and post-course knowledge assessments including image interpretation). Pre- and post-knowledge scores were presented using means and ranges. Percent improvements and a paired sample t-test with the effect size (Cohen\u0026rsquo;s d) were used to compare pre-post improvements. For course evaluation ratings, the mean Likert scale rating was calculated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 128 learners (103 paramedics, 22 flight nurses, and one EMS physician from 32 EMS agencies, as well as two United States Army medics, completed the course. The average age of participants was 39.0 years, and 98 (76.6%) were male. The pre-course assessment mean knowledge score was 67.6% (95% CI 64.7\u0026ndash;70.5). The post-course mean knowledge score was 89.0% (95% CI 87.3\u0026ndash;97.0), resulting in the 21.4 percentage point increase (p\u0026thinsp;\u0026lt;\u0026thinsp;.001; Cohen\u0026rsquo;\u003cem\u003es d\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.52). We received 122 course evaluations. Participants expressed nearly unanimous strong agreement across all measures, with a mean rating ranging from 4.8 to 4.9 on a 5-point Likert scale questionnaire.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur data suggests that an 8-hour POCUS course, incorporating e-learning and simulation, can significantly improve EMS providers\u0026rsquo; knowledge of the fundamentals of POCUS and image interpretation of eFAST examination in trauma patients. Course evaluation results are highly supportive of this course\u0026rsquo;s benefits. As EMS agencies increasingly incorporate POCUS for patient care, effective and efficient training methodologies will be critical for successful implementation. Our course offers one approach as part of a comprehensive training program. Further studies should assess POCUS utilization and sustained knowledge retention.\u003c/p\u003e","manuscriptTitle":"Effectiveness of a Simulation-based Point-of-care Ultrasound Course for Prehospital Providers - A Single Group Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 18:41:36","doi":"10.21203/rs.3.rs-5831070/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-26T04:28:47+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"39530746749413278155699984283042773161","date":"2025-04-06T08:54:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-25T23:33:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50254564247659742032762961780192831003","date":"2025-03-25T23:20:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-25T14:02:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-25T13:59:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-19T20:30:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07be7580-4a0e-46b6-8baa-c2d0b92b4d4e","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:08:31+00:00","versionOfRecord":{"articleIdentity":"rs-5831070","link":"https://doi.org/10.1186/s12909-025-07675-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-07-21 15:57:58","publishedOnDateReadable":"July 21st, 2025"},"versionCreatedAt":"2025-03-31 18:41:36","video":"","vorDoi":"10.1186/s12909-025-07675-w","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07675-w","workflowStages":[]},"version":"v1","identity":"rs-5831070","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5831070","identity":"rs-5831070","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}