Dr. Jonathan Warren discusses practical uses, evidence, and implementation challenges for prehospital ultrasound. We cover lung ultrasound for acute heart failure and B line quantification, trauma FAST exams, cardiac arrest applications including focused pulse checks and transesophageal echocardiography, and how prehospital transfusion and early diagnostics change diagnostic momentum on ED arrival. Dr. Warren also outlines real-world barriers to sustained uptake—cost, training, tech issues, clinical workflows—and describes a national survey from the ACEP prehospital/austere ultrasound subcommittee aimed at identifying why adoption often dwindles after initial implementation.