Impact of Acoustic Gunshot Detection Technology on Prehospital Transport and Time to Treatment: A Narrative Review With Directions for Future Military Conflicts

Introduction: Hemorrhage from traumatic injuries remains the leading cause of preventable death on the battlefield, with the majority of fatalities occurring before patients reach surgical care. Acoustic Gunshot Detection (AGD) technology, such as SoundThinking (formerly ShotSpotter) in civilian settings and Boomerang III in military applications, offers the potential to reduce prehospital time intervals through rapid detection and localization of gunfire. This narrative review examines the current evidence regarding AGD’s impact on time to treatment, prehospital transport, and potential applications in future large-scale combat operations (LSCO). Materials and Methods: A narrative review was conducted of published civilian and military literature evaluating the performance and outcomes associated with AGD technology. Key studies assessing AGD impact on prehospital time metrics, injury severity, resource utilization, and patient outcomes were analyzed. Additionally, the review explores the tactical and operational relevance of AGD systems for modern and future military engagements, particularly in austere and contested environments anticipated during LSCO. Results: Civilian studies suggest AGD systems may reduce response times by police and Emergency Medical Services (EMS), with some demonstrating shortened scene and transport intervals. However, the evidence remains inconsistent regarding improved patient survival or clinical outcomes. Acoustic Gunshot Detection-related patients often presented with more severe injuries and required greater resource utilization, yet mortality outcomes were not consistently different from non-AGD counterparts. In the military context, AGD systems like Boomerang have proven useful for threat localization but are not yet integrated into medical evacuation workflows. The utility of AGD in LSCO may lie in its potential to cue earlier Tactical Combat Casualty Care (TCCC) and point-of-injury interventions, rather than simply reducing transport times. Key challenges include system survivability, false positive rates, and vulnerability to electronic warfare. Conclusions: Acoustic Gunshot Detection technology shows promise for enhancing prehospital care by potentially accelerating recognition of gunfire events and initiating earlier medical responses. Although time-saving benefits have been demonstrated in some civilian studies, translation into improved outcomes remains unclear. For military medicine, AGD may offer enhanced battlefield awareness and support for earlier intervention during prolonged casualty care scenarios in LSCO. Rigorous testing in operationally relevant military environments, outcome-focused research, and integration into medical command and control systems are critical next steps for validating AGD’s role in improving trauma care and reducing preventable battlefield deaths.