Point-of-care ultrasound during trauma and critical care transport: a practical, safety-gated review.

Background: Air medical and critical care transport teams often treat severely injured or critically ill patients when imaging, laboratory testing, and specialist support are limited. Point-of-care ultrasound (POCUS) may support early recognition of reversible conditions, but its value depends on strict indication selection, operator competence, and interpretation rules that prevent false reassurance. Methods: This structured narrative review summarizes evidence and practical considerations for transport POCUS in trauma and critical care retrieval. The review is organized around a safety-gated framework and groups evidence by clinical use: extended FAST (eFAST) and lung ultrasound, shock assessment, cardiac arrest POCUS, ultrasound-guided procedures, workflow integration, governance, tele-mentoring, and research priorities. Main findings: Transport POCUS is most useful when it confirms a limited set of urgent, actionable findings. eFAST and thoracic ultrasound generally show high specificity but only moderate sensitivity; therefore, a clear positive finding may trigger action, whereas a negative or technically limited scan should not justify down-triage. Representative studies suggest that prehospital POCUS can influence care processes: one randomized multicenter trial reported that prehospital FAST reduced the median time to admission by 13 min and the median time to operative treatment by 15 min, while a prospective HEMS cohort found that POCUS was used in 34.5% of patients and had therapeutic consequences in 40.7%. However, evidence for mortality, complication reduction, and long-term patient-centered outcomes remains limited. Conclusion: Transport POCUS should function as a focused decision-support tool, not as a substitute for definitive imaging. Safe implementation requires clear scope, time caps, "indeterminate = not reassuring" rules, structured documentation, competency-based training, discrepancy review, and quality assurance. Future studies should move beyond feasibility and time-to-care endpoints to evaluate safety, false-negative harms, complications, and patient-centered outcomes.