The Faculty of Pre-Hospital Care at the Royal College of Surgeons of Edinburgh has published a national consensus statement on pre-hospital ultrasound. Its central message is simple: a scan must answer a focused question, change what you do, and never delay time-critical treatment or transport. If your service carries an ultrasound probe, this sets the standard for use, training and governance.
Why this matters
Point-of-care ultrasound (POCUS) means a clinician scanning at the patient’s side to answer one specific question, rather than a full radiology examination. POCUS entered the UK pre-hospital emergency medicine curriculum in 2012 and the FIMC (Fellowship in Immediate Medical Care) examination in 2021.
Use has run ahead of governance. A national survey run between 1 April and 31 July 2021, published in POCUS Journal in 2022, found that 17 of 19 responding helicopter emergency medical services (HEMS) and 4 of 8 responding ambulance trusts used POCUS. Only two HEMS organisations met the Royal College of Radiologists’ governance criteria. Formal image review and storage were uncommon. Of 89 allied health professionals and nurses who responded, 76 (85%) held no formal ultrasound accreditation. The authors called for national guidance. The evidence base is also thinner than in hospital.
What the researchers did
The statement was written by a development group of ten clinicians from paramedic and medical backgrounds, including HEMS and intensive care consultants, a critical care paramedic, an advanced clinical practitioner, and office holders from the Royal College of Emergency Medicine, the Intensive Care Society and IBTPHEM.
A scoping meeting on 7 January 2025 set the key questions. Searches of MEDLINE/PubMed, CINAHL and Embase were run on 5 February 2025. After de-duplication, 217 articles were screened independently by two reviewers. 116 were included, plus 16 found through citation chaining. A draft was discussed on 3 April 2025 under three headings: clinical application, governance, and training, then recirculated to all members for approval.
Recommendations were graded using the Shekelle hierarchy. All 14 are grade C or D, meaning they rest on lower-level evidence or expert opinion rather than trials. The document is dated April 2025 and was published on the Faculty website on 17 November 2025. It does not replace an earlier statement and is not a manual on how to scan.
What they found
On clinical application, diagnostic scanning should answer a focused question, change pre-hospital management and not delay time-critical interventions. Scans that would not change on-scene care, such as looking for free fluid in the abdomen, can be done en route if space and movement artefact allow. Procedural scanning, for example to guide vascular access or a nerve block, must not unnecessarily delay care or transport. Paramedics can scan autonomously within a governed system.
The statement is frank about limits. eFAST, meaning extended focused assessment with sonography in trauma, has lower sensitivity pre-hospital, so a negative scan should not on its own rule out abdominal injury. A single-point lung scan is not enough: scans should extend laterally and posteriorly because traumatic pneumothoraces can be loculated, and a negative scan does not exclude one. In cardiac arrest, a scan can show cardiac standstill, but JRCALC already supports stopping resuscitation without one. In traumatic arrest with suspected tamponade, scanning must not delay thoracotomy; no survivors were reported when thoracotomy occurred more than 15 minutes after arrest.
On governance, every service using ultrasound must nominate a clinical lead. Images must be stored securely, and the interpretation and decision recorded in the clinical record, in line with UK GDPR and the Data Protection Act 2018. Services need a documented framework covering scope, training, audit, quality assurance and quality control. Devices must be registered with the MHRA. Sterile gel is required for invasive procedures, broken skin or mucous membranes, immunocompromised or critically ill patients, and where an invasive procedure is likely within 24 hours. Outbreaks linked to gel, including Burkholderia cepacia, are cited.
On training, each clinician must be assessed as competent in each examination type by a trainer who is an experienced pre-hospital clinician, accredited in the modality (for example FUSIC, FAMUS or RCEM entrustment level 4) and trained in assessment. During training, a supervisor must review every scan, in person, by live stream or retrospectively. Organisations must keep a register of trained clinicians and records of sign-off, and build ultrasound into appraisal.
Strengths and limitations
The strengths are a structured literature search, blinded independent screening, and a multi-professional group that included paramedics. The governance recommendations deliberately mirror those of the Intensive Care Society, Society for Acute Medicine, RCEM, BMUS and the Royal College of Radiologists, so pre-hospital services work to the same standard as hospital colleagues.
The limitations are equally clear. Every recommendation is grade C or D. There was no formal Delphi process or voting threshold. The statement sets no minimum scan numbers, logbook size or supervision ratio. Two authors declared honoraria from ultrasound manufacturers. It is written for UK land ambulance and HEMS practice. Remote, rural and offshore settings are not addressed, so offshore and diver medics must apply the principles to their own environment.
What it means for your practice
- HEMS and critical care paramedics: check that your service has a named clinical lead, a scan register and a route for image storage and review. If your scans are not reviewed, raise it. Keep lung scans multi-point and repeat them if the patient deteriorates.
- Frontline paramedics: the statement supports paramedic-led scanning, but only inside a governed programme, not on the strength of a short course or a personal device. If a scan would not change your decision on scene, it should not extend scene time.
- Offshore and diver medics: if ultrasound is in your kit, the same rules apply: focused question, documented interpretation, image storage, and sign-off by an accredited trainer. Agree with your topside doctor what you are expected to scan.
- First responders: ultrasound is outside your scope, but the lesson applies: adjuncts must never delay transport or time-critical care.
Do not change your practice on the basis of one document. JRCALC and your employer’s protocols govern what you do. The statement sets a governance and training standard; it adds no new indications.
Reflect
- In which recent patients could a focused scan have changed an on-scene decision, and in which would it only have delayed transport?
- Does your service meet the five governance recommendations: clinical lead, image storage, documented framework, equipment policy and infection control?
- If you scan, when was your last supervised review, and how would you evidence competence at appraisal?
- How would you explain to a colleague why a negative eFAST or single-point lung scan does not rule out injury?
Read the original
- Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh: Pre-Hospital Ultrasound consensus statement (full PDF), 2025
- Faculty of Pre-Hospital Care news: Pre-Hospital Ultrasound Consensus Statement, 17 November 2025
- Faculty of Pre-Hospital Care: Consensus statements resource page
- Naeem et al, POCUS Journal: A National Survey of Prehospital Care Services of United Kingdom for Use, Governance and Perception of Prehospital Point of Care Ultrasound, 2022
Published 25 October 2026. Last reviewed October 2026.
These summaries are for education and CPD only. They are not clinical guidelines. Always practise within your scope of practice and follow your employer’s protocols and national guidance such as JRCALC and Resuscitation Council UK.