Hennepin EMS Enhances Emergency Response with Fleet-Wide Butterfly Integration
Overview
Hennepin EMS (HEMS) is a widely recognized leader in emergency medical services and has been providing medical transportation and care to the residents and visitors of Minneapolis and 13 Hennepin County suburbs since 1894. As a hospital-based EMS agency, HEMS is part of Hennepin Healthcare, a system that has supported the early adoption of Point-of-Care Ultrasound (POCUS) and enabled paramedics to harness handheld ultrasound devices in 2022.
Partnering with Butterfly Network, HEMS has integrated prehospital ultrasound across the entire agency to enhance diagnostics and patient care.
To date, HEMS has equipped all 40 ambulances with Butterfly iQ+™ devices, all linked with Butterfly’s Compass™ workflow software. All 210 paramedics have been trained in multiple ultrasound use cases and now regularly employ POCUS during clinical assessments. The insights gained through prehospital ultrasound have expedited transport and treatment, improved triage, and positively impacted patient outcomes.
Impact
probe-to-ambulance ratio.
Butterfly scans performed by Hennepin paramedics since rollout.
paramedics trained on Butterfly POCUS.
of scans reviewed for quality assurance.
of cardiac and lung exams significantly changed patient care decisions.
emergency transports in 2024.
All Hennepin EMS paramedics now use Butterfly iQ+ devices for both thoracic and cardiac ultrasound. Additionally, 30 paramedics have received advanced training to perform more comprehensive exams, including obstetric, aortic, and FAST assessments.
In 2024, while responding to 95,000 emergency calls and 65,000 transports, HEMS performed over 6,000 ultrasound scans, with 10% of cardiac and lung exams significantly changing patient care decisions. Ultrasound was used in 5.27% of all emergency incidents, helping paramedics diagnose high-acuity conditions such as pulmonary embolism, abdominal aortic aneurysm, and internal bleeding. With 100% of scans reviewed for quality assurance and 210 paramedics trained on Butterfly POCUS, ultrasound has become an integral tool in guiding rapid, effective treatment—particularly when symptoms are vague or inconclusive.
In many cases, paramedics have not only used the ultrasound training we gave them—they’ve gone above and beyond. They can better understand the anatomy and pathophysiology in real time in a different way with ultrasound.
Chief Medical Director, Hennepin EMS
Why Hennepin chose Butterfly
Before adopting Butterfly, only a small group of HEMS paramedics shared 10 ultrasound devices, which they carried individually. Their previous ultrasound solution had connectivity issues and limited users’ ability to perform quality assurance (QA) or utilize scans for education.
As the ultrasound program expanded, HEMS medical directors chose to scale pre-hospital POCUS and selected Butterfly for its single-probe, whole-body scanning system. Its platform had fewer potential points of failure between the iQ+ and the iPad—offering a more durable, hardwired solution—while the Compass workflow provided centralized image storage and streamlined documentation for paramedics.
Deployment
HEMS began its wider ultrasound rollout by creating the Advanced Practice Paramedic, or ‘P3 program,’ to train six paramedics in advanced ultrasound with a focus on critical care. Building on its success, the program expanded to include 20 paramedics, with three also trained to conduct regular quality assurance. As the program grew, lead paramedics observed that trainees were fully embracing Butterfly devices for POCUS, integrating them confidently into their workflow.
Following the success of the P3 program, the agency’s medical directors decided to expand ultrasound use agency-wide. Now, each ambulance is equipped with a Butterfly iQ+, mounted near the captain’s chair to remain charged when not in use and readily available for paramedics when needed. HEMS implemented a structured training rollout across the EMS team, starting with thoracic ultrasound and later adding cardiac applications. Newly hired paramedics—and now EMTs—receive ultrasound training as part of a four-week academy program, with continued education incorporated into twice-annual practicals.
The POCUS directors have demonstrated that paramedics and EMTs gain confidence using iQ+ after approximately 25 exams and feel proficient in image interpretation in the field after about 50 exams. They also found that ‘shadow shifts’—where medics learn from EM POCUS experts in the Hennepin Emergency Department—greatly enhance skill development. During these shifts, paramedics spend eight hours conducting ultrasound exams alongside the medical director, who provides real-time feedback and guidance.
Workflow
Before or during transport, paramedics use a Butterfly device to scan the patient. Based on their findings, they adjust treatment and communicate the likely clinical issue to the hospital team. They can also use the device and software to transmit POCUS images to physicians as needed.
After transferring care at the receiving hospital, medics complete customized worksheets in the Butterfly software. These worksheets feature pre-defined options, allowing medics to efficiently document the clinical presentation, ultrasound findings, and treatment decisions.
Before submitting an image set and worksheet to the Butterfly Cloud, medics can add notes and label images for effective QA and educational feedback. With Butterfly’s customizable worksheets, comprehensive documentation is typically completed in just 30 seconds.
Quality assurance is essential to ensure pre-hospital providers make the right patient care decisions with POCUS and receive timely feedback to enhance their skills. With Butterfly Compass enabling a structured QA approach, HEMS lead paramedics and medical directors review all studies for quality, continuous improvement, and insight into paramedics’ clinical decision-making.
Using ultrasound technology in this way is still so new. Prompt feedback on every exam ensures our team knows what they’re doing. When people become proficient in ultrasound, it’ll completely change how we do prehospital medicine.
Hennepin EMS Paramedic
The team adopts a positive, peer-to-peer approach to QA, with P3 paramedics reviewing images through the Butterfly software. Instead of offering feedback from a distance, QA leads remain readily available, allowing paramedics to follow up easily or request additional guidance when needed.
Patient outcomes supported by POCUS
As a result of expanding the ultrasound program, HEMS has incorporated ultrasound findings into treatments and protocols. By identifying clinical conditions earlier, medics are better able to initiate crucial medications or adjust their treatment protocols. Without POCUS, many of these treatments would be delayed.
Lung ultrasound is now the standard of care at HEMS for patients with respiratory complaints. When paramedic Hailey Kennedy assesses a patient with breathing difficulties, she immediately uses her Butterfly device—an exam that provides valuable insight in just 30 seconds. This allows her to begin treatment on the spot, transition the patient to the ambulance, perform follow-up assessments, and continue care throughout transport.
Ultrasound is my first step. Nothing else shows a clearer picture of the pathology that is going on.
Hennepin EMS Paramedic
Across Hennepin EMS, ultrasound has become a critical tool in prehospital care, influencing both treatment decisions and patient outcomes. POCUS has impacted patient care delivery in tangible ways, including:
- Supporting emergent field impressions. When paramedic Seth Bravender used ultrasound to assess a local teacher in respiratory distress, he quickly identified a pulmonary embolism. The paramedics expedited transport and shared their findings with the hospital team, enabling immediate treatment upon arrival.
- Expediting in-hospital treatment and improving triage. Paramedic Spencer Schwartz used ultrasound to examine a patient who had back pain radiating from her chest to her back and identified an abdominal aortic aneurysm (AAA). Ultrasound allowed the prehospital team to identify a life threatening surgical emergency and start the in-hospital team down a path they might not have otherwise considered.
- Calming anxious patients. Paramedic Sam Hanes notes that ultrasound is a powerful tool for reassuring patients. Paramedics can ease concerns by saying, “I took a picture of your heart, and it looks great.” Spencer has observed similar benefits with pregnant patients—during traumatic events like car accidents, a quick scan can confirm the fetus’s heartbeat in seconds, providing immediate relief.
Emergency departments are so backed up these days. With Butterfly, we can triage people better and make a much stronger case for seeing patients sooner.
Hennepin EMS Paramedic
Hailey estimates that once a week, ultrasound makes a critical difference in a patient’s outcome, whether through life-saving treatment or improved care.
Before the implementation of the agency-wide ultrasound program, Hailey often felt uncertain about patients’ conditions during transport. “I would feel at a loss, and nothing I was doing seemed to help. But now, those moments are becoming less frequent as I gain more tools—namely, ultrasound—and become more proficient with them.”
The Future of Prehospital Ultrasound
Numerous research studies indicate that POCUS can significantly impact patient management in the prehospital setting and should be considered a standard of care.¹,² Hennepin EMS’s implementation of Butterfly devices and software agency-wide demonstrates how ultrasound empowers paramedics to take a more active role in patient care long before hospital arrival.
For hospitals considering similar adoption, Chief Medical Director Dr. Nicholas Simpson emphasizes the importance of champions on both the medical direction and operations sides. Gaining buy-in requires strong advocates to drive rollout and ensure successful implementation at every stage.
Dr. Simpson likens ultrasound adoption to the early days of EKGs. “People thought, ‘We don’t need this,’ but now it would be unthinkable to evaluate a patient with chest pain or syncope without an EKG. I believe ultrasound is on the same path.”
Ultrasound still feels like such a new tool. But if you give paramedics the right equipment and enough time, you’ll start seeing cases where it completely transforms care. You have to trust the process.
Chief Medical Director, Hennepin EMS
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