Expeditionary Point-of-Care Ultrasound for Combat and Austere Environments

BACKGROUND: Point-of-care ultrasound (POCUS) enhances combat survivability, yet civilian standards often fail to address battlefield constraints. This scoping review delineates Expeditionary POCUS (E-POCUS) as a distinct capability. METHODS: A systematic scoping review following PRISMA-ScR guidelines searched PubMed, Embase, Web of Science, and Google Scholar through November 2025. Inclusion criteria targeted terrestrial austere and combat environments, strictly excluding hospital-based studies. We assessed quality using a modified GRADE framework. RESULTS: Fifty-three studies met the inclusion criteria. Data originated largely from civilian, resource-limited settings (34%) rather than from military zones (26%). Methodological quality was polarized: high-quality randomized trials supported artificial intelligence-assisted acquisition, while trauma protocols relied on very low-quality animal models. Analysis identified critical gaps in military-relevant POCUS standardization in equipment acquisition, training, and the application of ultrasound in austere and combat environments. CONCLUSION: E-POCUS requires a doctrine distinct from civilian standards. We propose a Best, Better, Minimum competency matrix to standardize training and justify the allocation of ultrasound equipment. We argue that to ensure the sustainability of standardized training in E-POCUS as a diagnostic capability, future research must validate these frameworks along with systemic quality improvement initiatives.