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Use of portable ultrasound in the field can facilitate the recognition of immediately life‐threatening causes of shock including intra‐abdominal bleeding and cardiac tamponade. Many EMS agencies, primarily air medical services, have deployed point‐of‐care ultrasound for field evaluations, including the focused assessment by sonography in trauma (FAST) examination, the EFAST incorporating a lung assessment for pneumothorax, and various shock protocols to assess volume status, a limited cardiac exam, or reversible causes of shock [28]. Ultimately, the EMS medical director must determine if the cost and effort required to acquire the equipment, training, and performance of these skills translates into improved patient outcomes. The use of field ultrasound has the potential to worsen patient outcome if the procedure delays the time to definitive care, does not influence patient destination or care, or interferes with maintenance of critical parameters such as airway, ventilation, and hemorrhage control.

There is growing interest in the use of biomarkers that can be employed to identify, monitor, and predict the outcome in shock [29]. Point‐of‐care testing devices make measurement of biomarkers in the field an attractive option. Elevation of serum lactate may reflect anaerobic tissue metabolism in acute sepsis and shock [29, 30]. In the setting of infection, elevated lactic acid may indicate septic shock and the need for early goal‐directed therapy. Elevated venous lactate is associated with increased mortality risk and the need for resuscitative care in trauma patients. Prehospital trauma research indicates that an elevated lactate level in the setting of trauma predicts the need for aggressive resuscitation [31]. Serial lactate measurements may indicate the effectiveness of ongoing resuscitation [32].

Prehospital telemedicine holds the promise of providing access to the highest levels of care to patients and field clinicians by using EMS as a “telemedicine facilitator” (see Chapter 73). In the event that the patient is in profound shock or extremis, EMS clinicians can engage a wide range of expertise to help manage the patient [33].

Artificial intelligence technology (“assisted intelligence”) is also uniquely suited to prehospital medicine. Diagnostic algorithms can interpret trends in data and identify patients who are in compensated shock prior to clinical deterioration [34]. Further recognition of those patterns may lead to individualized care in the form of direct decision support informing EMS clinicians in how to best care for their patients.