Point-of-care ultrasound (POCUS) use in mountain emergency medicine: results from an international online survey

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In urban settings, there is evidence that prehospital POCUS correlates well with in-hospital diagnostic results and can improve the treatment of patients without significantly prolonging time on-site. The extent to which POCUS is currently being used in international mountain emergency medicine has not yet been investigated. The aim of this study was to determine the current use of POCUS in mountain rescue organizations which are members of the International Commission for Alpine Rescue (ICAR). Methods We asked ICAR members to complete an online survey on their current use of POCUS during mountain rescue operations. The survey gathered information about staffing, ultrasound equipment, indications, perceived utility, and aspects of education and clinical supervision. Results Twelve of 39 included rescue organizations used POCUS when providing patient care in the field (31%, n = 12). POCUS was primarily available in organizations, which provide helicopter emergency medical services (HEMS), with or without additional terrestrial rescue services. Most rescue organizations used POCUS occasionally (64%, n = 7), depending on the provider, the type of rescue, and the encountered medical problem. POCUS was considered equally relevant in both medical and traumatic emergencies. Most providers considered that POCUS changed the treatment of their patients in the field (67%, n = 8). Half of the providers used standardized ultrasound protocols (50%, n = 6). Half of the rescue organizations did not record POCUS findings (50%, n = 6). Most rescue organizations did not have a framework in place for education and clinical supervision (91%, n = 10). Conclusions Our survey shows that POCUS currently plays a substantial role in international mountain emergency medicine. POCUS is primarily used during helicopter-based rescue but is also available in some organizations who provide terrestrial rescue. Most rescue providers use POCUS in select patient groups presenting with specific clinical conditions. The availability of POCUS during mountain rescue operations seems to influence on-site clinical decision-making. Although POCUS providers often use standardized protocols when performing examinations, aspects of education and clinical supervision will need to be addressed in the future. Echocardiography Emergency Medicine Mountain Medicine POCUS Ultrasound Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Point-of-care ultrasound (POCUS) is increasingly used prehospitally for both diagnostic and procedural applications. Due to improvements in skills and technology, currently available light-weight portable ultrasound devices can provide high-quality images comparable to traditional in-hospital equipment ( 1 ). Different assessment protocols have been successfully extrapolated from in-hospital care to the treatment of emergency patients in prehospital settings. Commonly used applications include the Extended Focused Assessment with Sonography in Trauma (eFAST) protocol for trauma, the Bedside Lung Ultrasound in Emergency (BLUE) protocol for respiratory distress, and the Rapid Ultrasound in Shock (RUSH) protocol for non-traumatic shock ( 2 – 4 ). Other potential applications are echocardiography for patients in cardiac arrest and the guidance of invasive prehospital procedures ( 5 ). In urban settings, there is evidence that prehospital POCUS correlates well with in-hospital diagnostic results and can improve the on-site treatment of patients, without substantially prolonging the total time of the rescue operation ( 6 – 8 ). Mountain rescue organizations must often provide emergency medical care in remote and austere environments under challenging conditions (e.g. difficult access, high altitude, adverse weather). Although the feasibility and potential indications of POCUS in such environments have been reviewed in the past ( 9 – 11 ), the extent to which POCUS is currently being used in mountain rescue has not yet been investigated. A previous survey has demonstrated that POCUS is implemented with success in 75% of European helicopter emergency services (HEMS) ( 12 ). Although this survey provided useful insight into the current role of POCUS in European helicopter rescue, which often operates in both urban and mountainous environments, the results are not representative for current practice in international mountain emergency medicine. The aim of this study was to investigate the current role of POCUS in mountain rescue across different countries and to guide the development of future recommendations of the International Commission for Alpine Rescue (ICAR) on the use of POCUS in international mountain emergency medicine. Methods ICAR is an independent non-profit organization, which provides a global platform for mountain rescue organizations ( 13 ). Its members conduct terrestrial and helicopter rescue in mountainous environments all over the world. We asked ICAR members to complete a survey on their current practice with POCUS during mountain rescue operations. The online survey was drafted and reviewed by a committee of six international experts in mountain rescue and mountain emergency medicine. All contributing experts were active members of the ICAR medical commission (MEDCOM). The questions were developed in a multiple-choice format, with some questions allowing multiple answers. Certain questions also incorporated a free-text field to permit respondents to provide a specific answer to the question. For consistency among international organizations, the survey was only provided in English, which is the official language of the ICAR MEDCOM (see Additional file 1). The survey was divided into four main sections. The first section aimed to gather operational and staffing information about the participating rescue organization. If the participant indicated that their rescue organization did not use POCUS, the survey ended after this first section. If the participant indicated that their organization did use POCUS, the remaining three sections became available for answering. These consecutive sections contained questions regarding device types, usage frequency, indications, perceived utility, challenges, and organizational frameworks related to POCUS implementation. After final approval from all committee members, an invitation to participate in the survey was sent via e-mail to representatives of ICAR organizations which were active in mountain rescue. ICAR member organizations who represented research institutions or educational centers were not included in this study. The survey was made available online from August 8 to November 31, 2024. Two reminders to participate were sent via e-mail in October and November 2024. ICAR MEDCOM representatives of the selected organizations were also invited to participate during the annual ICAR congress, which was held between October 15 and October 20, 2024, in Thessaloniki, Greece. For this survey, an exemption from ethical board approval was obtained through the Swiss Association of Research Ethics Committees (swissethics). No health-related personal data was collected by the survey. The survey data were collected using the Research Electronic Data Capture (REDCap) web application hosted by the Department of Clinical Research of the University of Bern in Switzerland. REDCap is a secure, web-based software platform designed to support data capture for research studies ( 14 , 15 ). To avoid bias, we excluded duplicate entries from the same rescue organization (Fig. 1 ). In this case, only the first answer submitted by the rescue organization was included in the final analysis. Entries received from organizations which were not affiliated with ICAR, possibly due to ICAR MEDCOM representatives working for multiple rescue organizations, were also excluded, as the exact role of these organizations in international mountain rescue could not be verified. The resulting manuscript was written in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) statement (see Additional file 2) ( 16 ). Results The survey invitation was sent to delegates of the 92 ICAR member organizations which are active in mountain rescue. We received a total of 53 answers from 28 different countries. After applying the exclusion criteria, a total of 39 answers (74%) were included in the final analysis. The general characteristics of the included rescue organizations are summarized in Table 1 . Table 1 Baseline characteristics of rescue organizations Geographical location N (total = 39) Asia 1 (3%) Australasia 2 (5%) Europe 27 (69%) North America 7 (18%) South America 2 (5%) Type of service Helicopter emergency medical service (HEMS) 3 (8%) Terrestrial service 20 (51%) Both 16 (41%) Voluntary or professional staffing Voluntary 21 (54%) Professional 10 (26%) Both 8 (21%) Physician staffing Yes 12 (31%) No 4 (10%) Partly (depending on availability) 23 (59%) Other professions Nurse 24 (62%) Paramedic (ALS provider) 23 (59%) Emergency medical technician (BLS provder) 24 (62%) Rescue specialist (mountain guide) 31 (79%) Out of these 39 participants, 12 participants indicated that their rescue organization uses POCUS when providing patient care in the field (31%, n = 12). The relationship between the availability of POCUS and the type of rescue service and specialization of the staff is shown in Table 2 . Table 2 Availability of POCUS according to type of rescue and staffing Does your organization provide POCUS? Yes (N = 12) No (N = 27) p N (total) Type of service 0.001 39 HEMS 2 (17%) 1 (4%) Terrestrial 1 (8%) 19 (70%) Both 9 (75%) 7 (26%) Staffing 0.002 39 Voluntary 2 (17%) 19 (70%) Professional 7 (58%) 3 (11%) Both 3 (25%) 5 (19%) Physician staffing 0.006 39 Yes 8 (67%) 4 (15%) No 0 (0%) 4 (15%) Partly (depending on availability) 4 (33%) 19 (70%) Most rescue organizations indicated that they used POCUS occasionally (64%, n = 7), depending on provider availability, the type of rescue, and the encountered medical problem or injury. More specifically, 67% (n = 8) of organizations indicated that they use POCUS in < 10% of their treated patients. Most rescue organizations have been using POCUS for more than 3 years (75%, n = 9). In rescue organizations where POCUS is currently not in use, 46% (n = 12) plan to implement POCUS in the future, whereas 54% (n = 14) do not. The ultrasound devices used by rescue organizations are typically hand-held, portable devices, which offer different probe types. The devices used by participants in our survey were Sonosite iViz (33%, n = 4), GE Healthcare Vscan (33%, n = 4), Clarius (17%, n = 2), and Butterfly Network (17%, n = 2). One rescue organization used an unspecified device (8%, n = 1). The most used probe type was a linear probe (67%, n = 8), followed by a curvilinear probe (58%, n = 7) and a phased array probe (25%, n = 3). User satisfaction for these devices was generally high. Technical issues encountered by rescuers were due to cold exposure (battery or touchscreen malfunction reported by 58% of participants (n = 7)) and/or light exposure (poor visibility of images in direct sunlight reported by 42% of participants (n = 5)). Other reported issues were due to poor connectivity in remote locations or because of connection issues between the probe and the display device (e.g. fragile cable connection, software issues). In all rescue organizations, POCUS was provided by physicians (100%, n = 12). In a minority of rescue organizations, POCUS was also provided by paramedics in addition to physicians (17%, n = 2). POCUS was considered at least moderately important for mountain rescue operations by 76% (n = 9) of providers (Fig. 2 ). Most participants considered POCUS to be equally relevant in both medical and traumatic emergencies (75%, n = 9). The main indications in which POCUS was used by rescue organizations are summarized in Table 3 . Table 3 – Main indications for the use of POCUS In which areas is POCUS used by your organization? N (total = 12) Abdomen 12 (100%) Airway 1 (8%) Echocardiography 9 (75%) Lungs 12 (100%) Neurology 3 (25%) Vascular 7 (58%) Other (regional anesthesia, musculoskeletal) 3 (25%) In which clinical conditions is POCUS used by your organization? Accidental hypothermia 3 (25%) Acute abdomen 5 (42%) Acute altitude illness 1 (8%) Cardiac arrest 11 (92%) Dyspnea 9 (72%) Non-traumatic shock 6 (50%) Traumatic shock 11 (92%) Other (pregnancy, musculoskeletal) 3 (25%) Does your organization use POCUS for procedural guidance? IV access 8 (67%) Pericardiocentesis 5 (42%) Regional anesthesia 6 (50%) Thoracocentesis 7 (58%) The estimated relevance attributed to POCUS by participants for each domain is illustrated in Figs. 3 and 4 . POCUS was considered most relevant for screening of the heart (75%, n = 9), abdomen (91%, n = 11), and lungs (92%, n = 11). POCUS was also considered most relevant for treating patients with acute abdomen (63%, n = 7), cardiac arrest (83%, n = 10), dyspnea (100%, n = 12), and both traumatic and non-traumatic shock (100%, n = 12 and 90%, n = 9, respectively). POCUS was considered relevant for all commonly performed prehospital invasive procedures (Fig. 5 ). In the experience of participants, 67% (n = 8) found that POCUS changed the treatment of their patients in the field. Half of the participants indicated that POCUS affected the outcome of their patients (50%, n = 6). Half of the rescue organizations used standardized ultrasound protocols (50%, n = 6). The eFAST protocol was the most frequently used (50%, n = 6), followed by the BLUE protocol (25%, n = 3) and the RUSH protocol (17%, n = 2). Half of the rescue organizations did not record POCUS findings (50%, n = 6), or only record them if the findings were relevant (25%, n = 3). The most cited reasons for not recording POCUS findings were technical limitations (25%, n = 3) and consumption of time (33%, n = 4). Most rescue organizations did not have access to telemedical assistance (83%, n = 10). Specific credentials (e.g. previous POCUS training or diploma) were usually not required for rescue providers to use POCUS during rescue missions (92%, n = 11) and most organizations did not have a framework in place for clinical supervision or quality control (91%, n = 10). Discussion Our survey provides new insights into the current role of POCUS in mountain emergency medicine. Twelve out of 39, or approximately one-third, of ICAR-affiliated mountain rescue organizations are currently able to provide POCUS during their rescue operations. In rescue organizations where POCUS is currently not in use, approximately half is planning to implement POCUS in the future. Light-weight portable devices with linear and curvilinear probes are most used and generally have a high user satisfaction. Technical issues which could limit the implementation of POCUS in the field are mainly due to cold and light exposure and connectivity issues. Even though POCUS providers are primarily physicians, some rescue organizations allow other qualified professionals such as paramedics to perform POCUS. According to survey participants, the availability of POCUS influences clinical decision-making and procedures in the field and affects patient outcomes. Although most providers use standardized and well-validated protocols, there seems to be a lack of consistency in the recording of POCUS findings as well as a lacking framework for education and clinical supervision. One of our key findings is that POCUS is primarily available in organizations who provide HEMS, with or without terrestrial rescue. Most organizations who provide only terrestrial rescue currently do not use POCUS. In addition, the availability of POCUS is more prevalent in professional (versus voluntary) organizations that have physicians on staff. Specifically, our study builds on a previous survey which found that POCUS protocols are currently used by 75% of European HEMS ( 12 ). In Europe, many HEMS operate in both urban and mountainous environments. Globally, however, the type of rescue service provided in mountainous regions is not uniform. As our results show, most rescue organizations provide either terrestrial rescue alone or in combination with HEMS. Only a small minority of organizations provide only HEMS. These results could be explained by the global differences in organization of mountain rescue services. Whereas mountain rescue in developed areas is often performed by professional organizations with access to helicopter-based services, local rescue teams in more remote and less developed areas might have to rely on volunteers to provide terrestrial rescue. These local teams often do not have the same equipment, funding and training as professional organizations. Furthermore, HEMS organizations are usually permanently staffed by physicians, whereas local mountain rescue teams might not always have a physician available. This disparity might explain why many professional HEMS organizations have already adopted POCUS, in contrast to only one-third of international mountain rescue organizations, as shown by our survey. It is encouraging to see, however, that almost half of the participating organizations wish to implement POCUS in the future. We cannot determine from our results why some organizations do, and others do not, wish to implement POCUS in the future. Our results show that most rescue organizations use POCUS in select groups of patients. The main anatomical regions of interest are the heart, the abdomen, and the lungs. The main indications are in patients with signs of acute abdomen, cardiac arrest, dyspnea, and patients in either traumatic or non-traumatic shock. This could explain why the eFAST protocol is the most used protocol reported in our survey, as it covers all these regions of interest and provides clinically relevant information for most reported indications. Our results are comparable to the survey findings on the use of POCUS in European HEMS, where providers used POCUS in approximately 15% of patients and attributed a similar degree of importance to the above-mentioned anatomical regions and clinical conditions ( 12 ). Similar results have been reported by other observational studies on the use of POCUS in prehospital settings. These studies were conducted in European countries, where land- and helicopter-based emergency medical services (EMS) reportedly used POCUS in 18–19% of patients ( 7 , 17 ). The most frequent indications in land-based EMS were dyspnea (38.4%), cardiac arrest (17.2%), and trauma (11.1%) ( 7 ). In HEMS, the most common POCUS examination was echocardiography (60%) for patients in cardiac arrest, followed by eFAST (32%) and lung ultrasound (13%) ( 17 ). Most participants in our survey found that the use of POCUS changed their clinical decision-making and treatment of patients in the field, thereby potentially affecting patient outcomes. This notion is also supported by observational data. In land-based EMS, ultrasound-related changes in patient management occurred in 49.5% of patients and impacted the destination hospital and the patient transport priority or monitoring requirements in 33.3% of cases ( 7 ). In a multi-center study of 202 patients with suspected abdominal injury, prehospital POCUS led to a change in treatment in 30% of patients and a change in destination hospital in 22% of patients ( 8 ). In a retrospective analysis of 1583 prehospital patients, abdominal ultrasound had an impact on treatment in 12.6% of patients by providing more information to the destination hospital (45.4%) and altering the mode of transportation (23.5%), choice of destination hospital (13.1%), and fluid management (11.6%) ( 18 ). Similar observational results were reported for prehospital lung ultrasound in 281 patients, with an impact on treatment in 21% of patients and changes to the destination hospital in 4% of patients ( 6 ). In another study, prehospital echocardiography during cardiopulmonary resuscitation (CPR) of 56 patients impacted decision-making in 88% of cases regarding termination of CPR (57%), fluid management (14%), drug selection and dosing (14%), and destination hospital (5%) ( 18 ). Although these observational results seem to indicate a benefit of POCUS for the treatment of patients in prehospital settings, there is potential concern when performing ultrasound examination under difficult circumstances, as is often the case during mountain rescue missions. In a simulated prehospital setting, for instance, 75% of ultrasound providers failed to notice a deterioration in their patient’s condition while performing an ultrasound examination ( 19 ). This finding emphasizes the importance of human factors and teamwork in complex situations where ultrasound examination can easily distract the provider. In addition, although observational data suggest that prehospital ultrasound findings can correlate well with the in-hospital diagnosis ( 7 ), a systematic review of the accuracy of prehospital lung ultrasound for the detection of pneumothorax has shown a high specificity (99%) with a highly variable and imprecise sensitivity (66%) ( 20 ). Lung ultrasound therefore seems to be best used to avoid unnecessary interventions, as in one study, where the decision to insert a chest tube was abandoned in 4% of cases after lung ultrasound was performed ( 6 ). Despite wide-spread international adoption of prehospital POCUS, some concerns still exist regarding the current lack of standardization in educational requirements and clinical supervision. Skill development through continuing education is critical for the successful application of POCUS in the field. Relevant findings should be documented, and the acquired images should be stored and made available for later review ( 5 ). Although most rescue organizations use standardized and well-validated protocols when performing POCUS, the recording of findings appears to be inconsistent and is done in varying formats. In addition, most rescue organizations do not require specific credentials for using POCUS and do not have a solution for clinical supervision. This is something that should be addressed in the future, as rescue organizations who have instituted a framework for education, image archiving, and clinical governance have been able to demonstrate a strong inter-rater reliability of POCUS findings ( 17 ). Such organizations have also been able to obtain similar image quality when comparing physicians and paramedics, which is encouraging for rescue organizations who are only partly physician staffed. Although telemedical support is currently unavailable to many rescue organizations, this could be another way to develop strategies for clinical supervision and quality control by internal or external experts. Limitations Our survey has several limitations. We only invited ICAR member organizations which are active in international mountain rescue. ICAR member organizations who represent research institutions or educational centers were not included in this study. In addition, there are other rescue organizations who are not affiliated with ICAR but still may provide POCUS during their rescue operations. Although we had a response rate of 42% to the survey, the absolute number of participating member organizations which currently use POCUS is small. There is also a potential responder bias (i.e. organizations that are already using POCUS may have been more likely to respond). It is therefore possible that our results are not entirely reflective of POCUS practices within international mountain rescue organizations. Conclusions Our survey shows that POCUS currently plays a substantial role in international mountain emergency medicine. POCUS is primarily used during helicopter-based rescue but is also available in some organizations who provide terrestrial rescue. Most rescue providers use POCUS in select patient groups presenting with specific clinical conditions. The availability of POCUS during mountain rescue operations seems to influence on-site clinical decision-making. Although POCUS providers often use standardized protocols when performing examinations, aspects of education and governance will need to be addressed in the future. Abbreviations BLUE - bedside lung ultrasound in emergency CPR - cardiopulmonary resuscitation eFAST - extended focused assessment with sonography in trauma EMS - emergency medical services HEMS - helicopter emergency medical services ICAR - International Commission for Alpine Rescue ICAR MEDCOM – International Commission for Mountain Emergency Medicine MEDCOM - Medical Commission POCUS - point-of-car ultrasound REDCap - Research Electronic Data Capture RUSH - rapid ultrasound in shock Declarations Ethics approval: The need for ethics approval was waived by the Swiss Association of Research Ethics Committees (swissethics). Our research was conducted in accordance with the established ethical guidelines of the Declaration of Helsinki. Consent to participate: Not applicable, as the manuscript does not contain data from any individual person. Consent for publication: Not applicable, as the manuscript does not contain data from any individual person. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: The authors received no funding for the research reported. Author’s contributions: NH designed the survey, analyzed and interpreted the data, wrote the first draft, and finalized the manuscript. NH helped to identify the ICAR MEDCOM organizations to be contacted and was a major contributor in writing the manuscript. MF critically reviewed the manuscript. SR and GS contributed to the interpretation of the results and critically reviewed the manuscript. PP supervised the project and was a major contributor in writing and reviewing the manuscript. All authors read and approved the final manuscript. Acknowledgements: The authors would like to acknowledge Dr. sc. nat. 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Additional Declarations No competing interests reported. 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Holthof","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3PsWoCMQDG8S8cxCXoGijoK0SEat/G4Fq6dLlBSkrhbro3EO8VOoljQqBTpKtDh7ulc910a9RSimCydsh/S+BHvgCp1H8sA9GARhcMyHN+vFIgKkhwIpR64tyRkAjBX7IpECfjTqbNHh99OqhMY5aTh0H5rHBYXyd3L3RqGT5HlHZnwqz4o3BGkcpdJ8IyYQErC8pub3YrLl+5VBkpQqT35YedCTcLLuu6jREGzX6J8k9sSYzQ0zb/l/uR0G9+mJPKVCHybtt2n9t+L3PDRs+fZF1a0xwC5AdenHUMpFKpVCrcN10NVZJ9YYKwAAAAAElFTkSuQmCC","orcid":"","institution":"University Hospital of Bern","correspondingAuthor":true,"prefix":"","firstName":"Niels","middleName":"","lastName":"Holthof","suffix":""},{"id":498415117,"identity":"032c2b56-2b01-4b27-8e68-79d0d86fb5af","order_by":1,"name":"Natalie Hölzl","email":"","orcid":"","institution":"Klinikverbund Allgäu","correspondingAuthor":false,"prefix":"","firstName":"Natalie","middleName":"","lastName":"Hölzl","suffix":""},{"id":498415119,"identity":"e2f17ea8-3db9-40b9-bfdc-e14c822e02b4","order_by":2,"name":"Juan Manuel Funk","email":"","orcid":"","institution":"University Hospital Regensburg","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Manuel","lastName":"Funk","suffix":""},{"id":498415123,"identity":"85c974c9-6235-415a-9b70-589feb921428","order_by":3,"name":"Simon Rauch","email":"","orcid":"","institution":"Ospedale di Merano","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Rauch","suffix":""},{"id":498415126,"identity":"ee1778a6-ac8d-4ab9-a7be-52b4cbab0d96","order_by":4,"name":"Giacomo Strapazzon","email":"","orcid":"","institution":"University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Giacomo","middleName":"","lastName":"Strapazzon","suffix":""},{"id":498415128,"identity":"6ad478b3-719e-405c-b4c5-a8f44e4c072a","order_by":5,"name":"Peter Paal","email":"","orcid":"","institution":"St. John of God Hospital","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Paal","suffix":""}],"badges":[],"createdAt":"2025-08-03 16:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7284526/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7284526/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-025-01456-w","type":"published","date":"2025-12-30T15:56:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88897579,"identity":"fac9d42c-4bb6-46ed-97ea-72ba19435120","added_by":"auto","created_at":"2025-08-12 13:12:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":158517,"visible":true,"origin":"","legend":"\u003cp\u003eInclusion and exclusion flow diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/63f5f8537e34fd2ebf020f51.png"},{"id":88899372,"identity":"e5ded8e9-5430-4a97-b9de-e0475264c6bb","added_by":"auto","created_at":"2025-08-12 13:28:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18167,"visible":true,"origin":"","legend":"\u003cp\u003eImportance of POCUS in mountain rescue\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/3d341afbdb1153620e8a1f8d.png"},{"id":88895895,"identity":"1e511f90-aa43-4a70-8e91-e3d2f1574ca4","added_by":"auto","created_at":"2025-08-12 13:04:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36131,"visible":true,"origin":"","legend":"\u003cp\u003eRelevance of POCUS per anatomical area\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/5f86d9c7b2eb9887a03da580.png"},{"id":88898392,"identity":"1049560a-7661-432f-92db-169937c3ee8a","added_by":"auto","created_at":"2025-08-12 13:20:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":44752,"visible":true,"origin":"","legend":"\u003cp\u003eRelevance of POCUS per clinical condition\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/90e2e57eee814ec2bdfd883a.png"},{"id":88897574,"identity":"07a0d8e4-7de4-4afa-b9a2-39c236e4ae0d","added_by":"auto","created_at":"2025-08-12 13:12:54","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":31727,"visible":true,"origin":"","legend":"\u003cp\u003eRelevance of POCUS for procedural guidance\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/524ffd8fbe6364ff3c85864f.png"},{"id":99545166,"identity":"4511e74b-9030-4966-97a6-2b4f911d5526","added_by":"auto","created_at":"2026-01-05 15:59:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":851504,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/9820ad68-bd5e-4d1a-b6c5-6cd1dfe3a27f.pdf"},{"id":88895894,"identity":"0318b2a4-10e2-4f53-a89f-f65fca3fbb4c","added_by":"auto","created_at":"2025-08-12 13:04:54","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":32617,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/50b122a493ed81f34d9d20d8.docx"},{"id":88898395,"identity":"7e6315fe-fbf2-4bd9-bbd0-4cf5db12857a","added_by":"auto","created_at":"2025-08-12 13:20:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18319,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7284526/v1/43f35e58a2287cbc8e85a70b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Point-of-care ultrasound (POCUS) use in mountain emergency medicine: results from an international online survey","fulltext":[{"header":"Background","content":"\u003cp\u003ePoint-of-care ultrasound (POCUS) is increasingly used prehospitally for both diagnostic and procedural applications. Due to improvements in skills and technology, currently available light-weight portable ultrasound devices can provide high-quality images comparable to traditional in-hospital equipment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Different assessment protocols have been successfully extrapolated from in-hospital care to the treatment of emergency patients in prehospital settings. Commonly used applications include the Extended Focused Assessment with Sonography in Trauma (eFAST) protocol for trauma, the Bedside Lung Ultrasound in Emergency (BLUE) protocol for respiratory distress, and the Rapid Ultrasound in Shock (RUSH) protocol for non-traumatic shock (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Other potential applications are echocardiography for patients in cardiac arrest and the guidance of invasive prehospital procedures (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In urban settings, there is evidence that prehospital POCUS correlates well with in-hospital diagnostic results and can improve the on-site treatment of patients, without substantially prolonging the total time of the rescue operation (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMountain rescue organizations must often provide emergency medical care in remote and austere environments under challenging conditions (e.g. difficult access, high altitude, adverse weather). Although the feasibility and potential indications of POCUS in such environments have been reviewed in the past (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), the extent to which POCUS is currently being used in mountain rescue has not yet been investigated. A previous survey has demonstrated that POCUS is implemented with success in 75% of European helicopter emergency services (HEMS) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Although this survey provided useful insight into the current role of POCUS in European helicopter rescue, which often operates in both urban and mountainous environments, the results are not representative for current practice in international mountain emergency medicine.\u003c/p\u003e\u003cp\u003eThe aim of this study was to investigate the current role of POCUS in mountain rescue across different countries and to guide the development of future recommendations of the International Commission for Alpine Rescue (ICAR) on the use of POCUS in international mountain emergency medicine.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eICAR is an independent non-profit organization, which provides a global platform for mountain rescue organizations (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Its members conduct terrestrial and helicopter rescue in mountainous environments all over the world. We asked ICAR members to complete a survey on their current practice with POCUS during mountain rescue operations. The online survey was drafted and reviewed by a committee of six international experts in mountain rescue and mountain emergency medicine. All contributing experts were active members of the ICAR medical commission (MEDCOM). The questions were developed in a multiple-choice format, with some questions allowing multiple answers. Certain questions also incorporated a free-text field to permit respondents to provide a specific answer to the question. For consistency among international organizations, the survey was only provided in English, which is the official language of the ICAR MEDCOM (see Additional file 1).\u003c/p\u003e\u003cp\u003eThe survey was divided into four main sections. The first section aimed to gather operational and staffing information about the participating rescue organization. If the participant indicated that their rescue organization did not use POCUS, the survey ended after this first section. If the participant indicated that their organization did use POCUS, the remaining three sections became available for answering. These consecutive sections contained questions regarding device types, usage frequency, indications, perceived utility, challenges, and organizational frameworks related to POCUS implementation.\u003c/p\u003e\u003cp\u003eAfter final approval from all committee members, an invitation to participate in the survey was sent via e-mail to representatives of ICAR organizations which were active in mountain rescue. ICAR member organizations who represented research institutions or educational centers were not included in this study. The survey was made available online from August 8 to November 31, 2024. Two reminders to participate were sent via e-mail in October and November 2024. ICAR MEDCOM representatives of the selected organizations were also invited to participate during the annual ICAR congress, which was held between October 15 and October 20, 2024, in Thessaloniki, Greece.\u003c/p\u003e\u003cp\u003eFor this survey, an exemption from ethical board approval was obtained through the Swiss Association of Research Ethics Committees (swissethics). No health-related personal data was collected by the survey. The survey data were collected using the Research Electronic Data Capture (REDCap) web application hosted by the Department of Clinical Research of the University of Bern in Switzerland. REDCap is a secure, web-based software platform designed to support data capture for research studies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). To avoid bias, we excluded duplicate entries from the same rescue organization (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In this case, only the first answer submitted by the rescue organization was included in the final analysis. Entries received from organizations which were not affiliated with ICAR, possibly due to ICAR MEDCOM representatives working for multiple rescue organizations, were also excluded, as the exact role of these organizations in international mountain rescue could not be verified. The resulting manuscript was written in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) statement (see Additional file 2) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe survey invitation was sent to delegates of the 92 ICAR member organizations which are active in mountain rescue. We received a total of 53 answers from 28 different countries. After applying the exclusion criteria, a total of 39 answers (74%) were included in the final analysis. The general characteristics of the included rescue organizations are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of rescue organizations\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeographical location\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (total\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAustralasia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEurope\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (69%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of service\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHelicopter emergency medical service (HEMS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTerrestrial service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (51%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (41%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVoluntary or professional staffing\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVoluntary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (54%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysician staffing\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (31%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (10%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartly (depending on availability)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (59%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther professions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (62%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParamedic (ALS provider)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (59%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency medical technician (BLS provder)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (62%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRescue specialist (mountain guide)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (79%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOut of these 39 participants, 12 participants indicated that their rescue organization uses POCUS when providing patient care in the field (31%, n\u0026thinsp;=\u0026thinsp;12). The relationship between the availability of POCUS and the type of rescue service and specialization of the staff is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAvailability of POCUS according to type of rescue and staffing\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes your organization provide POCUS?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN (total)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of service\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHEMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTerrestrial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStaffing\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVoluntary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysician staffing\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartly (depending on availability)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMost rescue organizations indicated that they used POCUS occasionally (64%, n\u0026thinsp;=\u0026thinsp;7), depending on provider availability, the type of rescue, and the encountered medical problem or injury. More specifically, 67% (n\u0026thinsp;=\u0026thinsp;8) of organizations indicated that they use POCUS in \u0026lt;\u0026thinsp;10% of their treated patients. Most rescue organizations have been using POCUS for more than 3 years (75%, n\u0026thinsp;=\u0026thinsp;9). In rescue organizations where POCUS is currently not in use, 46% (n\u0026thinsp;=\u0026thinsp;12) plan to implement POCUS in the future, whereas 54% (n\u0026thinsp;=\u0026thinsp;14) do not.\u003c/p\u003e\u003cp\u003eThe ultrasound devices used by rescue organizations are typically hand-held, portable devices, which offer different probe types. The devices used by participants in our survey were Sonosite iViz (33%, n\u0026thinsp;=\u0026thinsp;4), GE Healthcare Vscan (33%, n\u0026thinsp;=\u0026thinsp;4), Clarius (17%, n\u0026thinsp;=\u0026thinsp;2), and Butterfly Network (17%, n\u0026thinsp;=\u0026thinsp;2). One rescue organization used an unspecified device (8%, n\u0026thinsp;=\u0026thinsp;1). The most used probe type was a linear probe (67%, n\u0026thinsp;=\u0026thinsp;8), followed by a curvilinear probe (58%, n\u0026thinsp;=\u0026thinsp;7) and a phased array probe (25%, n\u0026thinsp;=\u0026thinsp;3). User satisfaction for these devices was generally high. Technical issues encountered by rescuers were due to cold exposure (battery or touchscreen malfunction reported by 58% of participants (n\u0026thinsp;=\u0026thinsp;7)) and/or light exposure (poor visibility of images in direct sunlight reported by 42% of participants (n\u0026thinsp;=\u0026thinsp;5)). Other reported issues were due to poor connectivity in remote locations or because of connection issues between the probe and the display device (e.g. fragile cable connection, software issues).\u003c/p\u003e\u003cp\u003eIn all rescue organizations, POCUS was provided by physicians (100%, n\u0026thinsp;=\u0026thinsp;12). In a minority of rescue organizations, POCUS was also provided by paramedics in addition to physicians (17%, n\u0026thinsp;=\u0026thinsp;2). POCUS was considered at least moderately important for mountain rescue operations by 76% (n\u0026thinsp;=\u0026thinsp;9) of providers (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Most participants considered POCUS to be equally relevant in both medical and traumatic emergencies (75%, n\u0026thinsp;=\u0026thinsp;9). The main indications in which POCUS was used by rescue organizations are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Main indications for the use of POCUS\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn which areas is POCUS used by your organization?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (total\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAirway\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEchocardiography\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (75%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLungs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeurology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVascular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (58%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (regional anesthesia, musculoskeletal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIn which clinical conditions is POCUS used by your organization?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccidental hypothermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute abdomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (42%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute altitude illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiac arrest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (92%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyspnea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (72%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-traumatic shock\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraumatic shock\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (92%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (pregnancy, musculoskeletal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDoes your organization use POCUS for procedural guidance?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIV access\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (67%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePericardiocentesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (42%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegional anesthesia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThoracocentesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (58%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe estimated relevance attributed to POCUS by participants for each domain is illustrated in Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. POCUS was considered most relevant for screening of the heart (75%, n\u0026thinsp;=\u0026thinsp;9), abdomen (91%, n\u0026thinsp;=\u0026thinsp;11), and lungs (92%, n\u0026thinsp;=\u0026thinsp;11). POCUS was also considered most relevant for treating patients with acute abdomen (63%, n\u0026thinsp;=\u0026thinsp;7), cardiac arrest (83%, n\u0026thinsp;=\u0026thinsp;10), dyspnea (100%, n\u0026thinsp;=\u0026thinsp;12), and both traumatic and non-traumatic shock (100%, n\u0026thinsp;=\u0026thinsp;12 and 90%, n\u0026thinsp;=\u0026thinsp;9, respectively). POCUS was considered relevant for all commonly performed prehospital invasive procedures (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In the experience of participants, 67% (n\u0026thinsp;=\u0026thinsp;8) found that POCUS changed the treatment of their patients in the field. Half of the participants indicated that POCUS affected the outcome of their patients (50%, n\u0026thinsp;=\u0026thinsp;6).\u003c/p\u003e\u003cp\u003eHalf of the rescue organizations used standardized ultrasound protocols (50%, n\u0026thinsp;=\u0026thinsp;6). The eFAST protocol was the most frequently used (50%, n\u0026thinsp;=\u0026thinsp;6), followed by the BLUE protocol (25%, n\u0026thinsp;=\u0026thinsp;3) and the RUSH protocol (17%, n\u0026thinsp;=\u0026thinsp;2). Half of the rescue organizations did not record POCUS findings (50%, n\u0026thinsp;=\u0026thinsp;6), or only record them if the findings were relevant (25%, n\u0026thinsp;=\u0026thinsp;3). The most cited reasons for not recording POCUS findings were technical limitations (25%, n\u0026thinsp;=\u0026thinsp;3) and consumption of time (33%, n\u0026thinsp;=\u0026thinsp;4). Most rescue organizations did not have access to telemedical assistance (83%, n\u0026thinsp;=\u0026thinsp;10). Specific credentials (e.g. previous POCUS training or diploma) were usually not required for rescue providers to use POCUS during rescue missions (92%, n\u0026thinsp;=\u0026thinsp;11) and most organizations did not have a framework in place for clinical supervision or quality control (91%, n\u0026thinsp;=\u0026thinsp;10).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur survey provides new insights into the current role of POCUS in mountain emergency medicine. Twelve out of 39, or approximately one-third, of ICAR-affiliated mountain rescue organizations are currently able to provide POCUS during their rescue operations. In rescue organizations where POCUS is currently not in use, approximately half is planning to implement POCUS in the future. Light-weight portable devices with linear and curvilinear probes are most used and generally have a high user satisfaction. Technical issues which could limit the implementation of POCUS in the field are mainly due to cold and light exposure and connectivity issues. Even though POCUS providers are primarily physicians, some rescue organizations allow other qualified professionals such as paramedics to perform POCUS. According to survey participants, the availability of POCUS influences clinical decision-making and procedures in the field and affects patient outcomes. Although most providers use standardized and well-validated protocols, there seems to be a lack of consistency in the recording of POCUS findings as well as a lacking framework for education and clinical supervision.\u003c/p\u003e\u003cp\u003eOne of our key findings is that POCUS is primarily available in organizations who provide HEMS, with or without terrestrial rescue. Most organizations who provide only terrestrial rescue currently do not use POCUS. In addition, the availability of POCUS is more prevalent in professional (versus voluntary) organizations that have physicians on staff. Specifically, our study builds on a previous survey which found that POCUS protocols are currently used by 75% of European HEMS (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In Europe, many HEMS operate in both urban and mountainous environments. Globally, however, the type of rescue service provided in mountainous regions is not uniform. As our results show, most rescue organizations provide either terrestrial rescue alone or in combination with HEMS. Only a small minority of organizations provide only HEMS.\u003c/p\u003e\u003cp\u003eThese results could be explained by the global differences in organization of mountain rescue services. Whereas mountain rescue in developed areas is often performed by professional organizations with access to helicopter-based services, local rescue teams in more remote and less developed areas might have to rely on volunteers to provide terrestrial rescue. These local teams often do not have the same equipment, funding and training as professional organizations. Furthermore, HEMS organizations are usually permanently staffed by physicians, whereas local mountain rescue teams might not always have a physician available. This disparity might explain why many professional HEMS organizations have already adopted POCUS, in contrast to only one-third of international mountain rescue organizations, as shown by our survey. It is encouraging to see, however, that almost half of the participating organizations wish to implement POCUS in the future. We cannot determine from our results why some organizations do, and others do not, wish to implement POCUS in the future.\u003c/p\u003e\u003cp\u003eOur results show that most rescue organizations use POCUS in select groups of patients. The main anatomical regions of interest are the heart, the abdomen, and the lungs. The main indications are in patients with signs of acute abdomen, cardiac arrest, dyspnea, and patients in either traumatic or non-traumatic shock. This could explain why the eFAST protocol is the most used protocol reported in our survey, as it covers all these regions of interest and provides clinically relevant information for most reported indications. Our results are comparable to the survey findings on the use of POCUS in European HEMS, where providers used POCUS in approximately 15% of patients and attributed a similar degree of importance to the above-mentioned anatomical regions and clinical conditions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Similar results have been reported by other observational studies on the use of POCUS in prehospital settings. These studies were conducted in European countries, where land- and helicopter-based emergency medical services (EMS) reportedly used POCUS in 18\u0026ndash;19% of patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The most frequent indications in land-based EMS were dyspnea (38.4%), cardiac arrest (17.2%), and trauma (11.1%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In HEMS, the most common POCUS examination was echocardiography (60%) for patients in cardiac arrest, followed by eFAST (32%) and lung ultrasound (13%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost participants in our survey found that the use of POCUS changed their clinical decision-making and treatment of patients in the field, thereby potentially affecting patient outcomes. This notion is also supported by observational data. In land-based EMS, ultrasound-related changes in patient management occurred in 49.5% of patients and impacted the destination hospital and the patient transport priority or monitoring requirements in 33.3% of cases (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In a multi-center study of 202 patients with suspected abdominal injury, prehospital POCUS led to a change in treatment in 30% of patients and a change in destination hospital in 22% of patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In a retrospective analysis of 1583 prehospital patients, abdominal ultrasound had an impact on treatment in 12.6% of patients by providing more information to the destination hospital (45.4%) and altering the mode of transportation (23.5%), choice of destination hospital (13.1%), and fluid management (11.6%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Similar observational results were reported for prehospital lung ultrasound in 281 patients, with an impact on treatment in 21% of patients and changes to the destination hospital in 4% of patients (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In another study, prehospital echocardiography during cardiopulmonary resuscitation (CPR) of 56 patients impacted decision-making in 88% of cases regarding termination of CPR (57%), fluid management (14%), drug selection and dosing (14%), and destination hospital (5%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough these observational results seem to indicate a benefit of POCUS for the treatment of patients in prehospital settings, there is potential concern when performing ultrasound examination under difficult circumstances, as is often the case during mountain rescue missions. In a simulated prehospital setting, for instance, 75% of ultrasound providers failed to notice a deterioration in their patient\u0026rsquo;s condition while performing an ultrasound examination (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This finding emphasizes the importance of human factors and teamwork in complex situations where ultrasound examination can easily distract the provider. In addition, although observational data suggest that prehospital ultrasound findings can correlate well with the in-hospital diagnosis (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), a systematic review of the accuracy of prehospital lung ultrasound for the detection of pneumothorax has shown a high specificity (99%) with a highly variable and imprecise sensitivity (66%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Lung ultrasound therefore seems to be best used to avoid unnecessary interventions, as in one study, where the decision to insert a chest tube was abandoned in 4% of cases after lung ultrasound was performed (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite wide-spread international adoption of prehospital POCUS, some concerns still exist regarding the current lack of standardization in educational requirements and clinical supervision. Skill development through continuing education is critical for the successful application of POCUS in the field. Relevant findings should be documented, and the acquired images should be stored and made available for later review (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Although most rescue organizations use standardized and well-validated protocols when performing POCUS, the recording of findings appears to be inconsistent and is done in varying formats. In addition, most rescue organizations do not require specific credentials for using POCUS and do not have a solution for clinical supervision. This is something that should be addressed in the future, as rescue organizations who have instituted a framework for education, image archiving, and clinical governance have been able to demonstrate a strong inter-rater reliability of POCUS findings (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Such organizations have also been able to obtain similar image quality when comparing physicians and paramedics, which is encouraging for rescue organizations who are only partly physician staffed. Although telemedical support is currently unavailable to many rescue organizations, this could be another way to develop strategies for clinical supervision and quality control by internal or external experts.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eOur survey has several limitations. We only invited ICAR member organizations which are active in international mountain rescue. ICAR member organizations who represent research institutions or educational centers were not included in this study. In addition, there are other rescue organizations who are not affiliated with ICAR but still may provide POCUS during their rescue operations. Although we had a response rate of 42% to the survey, the absolute number of participating member organizations which currently use POCUS is small. There is also a potential responder bias (i.e. organizations that are already using POCUS may have been more likely to respond). It is therefore possible that our results are not entirely reflective of POCUS practices within international mountain rescue organizations.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur survey shows that POCUS currently plays a substantial role in international mountain emergency medicine. POCUS is primarily used during helicopter-based rescue but is also available in some organizations who provide terrestrial rescue. Most rescue providers use POCUS in select patient groups presenting with specific clinical conditions. The availability of POCUS during mountain rescue operations seems to influence on-site clinical decision-making. Although POCUS providers often use standardized protocols when performing examinations, aspects of education and governance will need to be addressed in the future.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBLUE - bedside lung ultrasound in emergency\u003c/p\u003e\n\u003cp\u003eCPR - cardiopulmonary resuscitation\u003c/p\u003e\n\u003cp\u003eeFAST - extended focused assessment with sonography in trauma\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEMS - emergency medical services\u003c/p\u003e\n\u003cp\u003eHEMS - helicopter emergency medical services\u003c/p\u003e\n\u003cp\u003eICAR - International Commission for Alpine Rescue\u003c/p\u003e\n\u003cp\u003eICAR MEDCOM \u0026ndash; International Commission for Mountain Emergency Medicine\u003c/p\u003e\n\u003cp\u003eMEDCOM - Medical Commission\u003c/p\u003e\n\u003cp\u003ePOCUS - point-of-car ultrasound\u003c/p\u003e\n\u003cp\u003eREDCap - Research Electronic Data Capture\u003c/p\u003e\n\u003cp\u003eRUSH - rapid ultrasound in shock\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval: The need for ethics approval was waived by the Swiss Association of Research Ethics Committees (swissethics). Our research was conducted in accordance with the established ethical guidelines of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent to participate: Not applicable, as the manuscript does not contain data from any individual person.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable, as the manuscript does not contain data from any individual person.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: The authors received no funding for the research reported.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions: NH designed the survey, analyzed and interpreted the data, wrote the first draft, and finalized the manuscript. NH helped to identify the ICAR MEDCOM organizations to be contacted and was a major contributor in writing the manuscript. MF critically reviewed the manuscript. SR and GS contributed to the interpretation of the results and critically reviewed the manuscript. PP supervised the project and was a major contributor in writing and reviewing the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors would like to acknowledge Dr. sc. nat. Markus Huber from the Department for BioMedical Research of the University of Bern in Switzerland for his help with the statistical analysis of the survey results.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNelson BP, Sanghvi A. Out of hospital point of care ultrasound: current use models and future directions. Eur J Trauma Emerg Surg. 2016;42(2):139\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eLichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117\u0026ndash;25.\u003c/li\u003e\n\u003cli\u003ePerera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am. 2010;28(1):29\u0026ndash;56, vii.\u003c/li\u003e\n\u003cli\u003eSavoia P, Jayanthi SK, Chammas MC. Focused Assessment with Sonography for Trauma (FAST). J Med Ultrasound. 2023;31(2):101\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eAmaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med. 2020;8:2050312120932706.\u003c/li\u003e\n\u003cli\u003eKetelaars R, Hoogerwerf N, Scheffer GJ. Prehospital chest ultrasound by a dutch helicopter emergency medical service. J Emerg Med. 2013;44(4):811\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eScharonow M, Weilbach C. Prehospital point-of-care emergency ultrasound: a cohort study. Scand J Trauma Resusc Emerg Med. 2018;26(1):49.\u003c/li\u003e\n\u003cli\u003eWalcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, et al. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg. 2006;93(2):238\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eCanepa CA, Harris NS. Ultrasound in Austere Environments. High Alt Med Biol. 2019;20(2):103\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eNelson BP, Melnick ER, Li J. Portable ultrasound for remote environments, Part I: Feasibility of field deployment. J Emerg Med. 2011;40(2):190\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eNelson BP, Melnick ER, Li J. Portable ultrasound for remote environments, part II: current indications. J Emerg Med. 2011;40(3):313\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eHilbert-Carius P, Struck MF, Rudolph M, Knapp J, Rognas L, Adler J, et al. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand J Trauma Resusc Emerg Med. 2021;29(1):124.\u003c/li\u003e\n\u003cli\u003eInternational Commission for Alpine Rescue. https://www.alpine-rescue.org. Accessed 26 July 2025.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u0026apos;Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377\u0026ndash;81.\u003c/li\u003e\n\u003cli\u003eEysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34.\u003c/li\u003e\n\u003cli\u003eAziz S, Edmunds CT, Barratt J. Implementation of a point-of-care ultrasound archiving system and governance framework in a UK physician-paramedic staffed helicopter emergency medical service. Scand J Trauma Resusc Emerg Med. 2024;32(1):49.\u003c/li\u003e\n\u003cli\u003eKetelaars R, Beekers C, Van Geffen GJ, Scheffer GJ, Hoogerwerf N. Prehospital Echocardiography During Resuscitation Impacts Treatment in a Physician-Staffed Helicopter Emergency Medical Service: an Observational Study. Prehosp Emerg Care. 2018;22(4):406\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003evan der Geest Y, Marengo L, Albrecht R, Buehler PK, Wendel-Garcia PD, Hofmaenner DA, et al. Prehospital ultrasound constitutes a potential distraction from the observation of critically ill patients: a prospective simulation study. Scand J Trauma Resusc Emerg Med. 2024;32(1):109.\u003c/li\u003e\n\u003cli\u003eGriffiths E. Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2021;29(1):163.\u003c/li\u003e\n\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-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Echocardiography, Emergency Medicine, Mountain Medicine, POCUS, Ultrasound","lastPublishedDoi":"10.21203/rs.3.rs-7284526/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7284526/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePoint-of-care ultrasound (POCUS) is increasingly used prehospitally for both diagnostic and procedural applications. In urban settings, there is evidence that prehospital POCUS correlates well with in-hospital diagnostic results and can improve the treatment of patients without significantly prolonging time on-site. The extent to which POCUS is currently being used in international mountain emergency medicine has not yet been investigated. The aim of this study was to determine the current use of POCUS in mountain rescue organizations which are members of the International Commission for Alpine Rescue (ICAR).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe asked ICAR members to complete an online survey on their current use of POCUS during mountain rescue operations. The survey gathered information about staffing, ultrasound equipment, indications, perceived utility, and aspects of education and clinical supervision.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTwelve of 39 included rescue organizations used POCUS when providing patient care in the field (31%, n\u0026thinsp;=\u0026thinsp;12). POCUS was primarily available in organizations, which provide helicopter emergency medical services (HEMS), with or without additional terrestrial rescue services. Most rescue organizations used POCUS occasionally (64%, n\u0026thinsp;=\u0026thinsp;7), depending on the provider, the type of rescue, and the encountered medical problem. POCUS was considered equally relevant in both medical and traumatic emergencies. Most providers considered that POCUS changed the treatment of their patients in the field (67%, n\u0026thinsp;=\u0026thinsp;8). Half of the providers used standardized ultrasound protocols (50%, n\u0026thinsp;=\u0026thinsp;6). Half of the rescue organizations did not record POCUS findings (50%, n\u0026thinsp;=\u0026thinsp;6). Most rescue organizations did not have a framework in place for education and clinical supervision (91%, n\u0026thinsp;=\u0026thinsp;10).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eOur survey shows that POCUS currently plays a substantial role in international mountain emergency medicine. POCUS is primarily used during helicopter-based rescue but is also available in some organizations who provide terrestrial rescue. Most rescue providers use POCUS in select patient groups presenting with specific clinical conditions. The availability of POCUS during mountain rescue operations seems to influence on-site clinical decision-making. Although POCUS providers often use standardized protocols when performing examinations, aspects of education and clinical supervision will need to be addressed in the future.\u003c/p\u003e","manuscriptTitle":"Point-of-care ultrasound (POCUS) use in mountain emergency medicine: results from an international online survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 13:04:49","doi":"10.21203/rs.3.rs-7284526/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-01T04:49:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T14:18:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107623448421611826476403737833496689908","date":"2025-08-23T02:44:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241056675635716841819953423375612763068","date":"2025-08-22T13:27:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-21T22:18:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152312009835332864417706469041181217245","date":"2025-08-21T14:02:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T20:11:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133328696369242626440023712922198670057","date":"2025-08-12T13:58:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313573478241681136979020104007320086243","date":"2025-08-09T09:10:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-07T06:30:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-06T07:57:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T09:35:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-05T09:33:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-08-03T16:21:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e61c38f6-d6c9-4d6a-bb52-3e9367135a3e","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T15:58:45+00:00","versionOfRecord":{"articleIdentity":"rs-7284526","link":"https://doi.org/10.1186/s12873-025-01456-w","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2025-12-30 15:56:53","publishedOnDateReadable":"December 30th, 2025"},"versionCreatedAt":"2025-08-12 13:04:49","video":"","vorDoi":"10.1186/s12873-025-01456-w","vorDoiUrl":"https://doi.org/10.1186/s12873-025-01456-w","workflowStages":[]},"version":"v1","identity":"rs-7284526","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7284526","identity":"rs-7284526","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}