Background. Portable point-of-care ultrasound (POCUS) is increasingly used in out-of-hospital emergency medical care; however, comprehensive experience with its implementation in a large urban (regional) EMS system, including staff training, methodological standardization, and telemedicine support, remains limited. Aim. To present the experience of implementing ultrasound diagnostics in the Moscow EMS system using the A.S. Puchkov Emergency and Urgent Medical Care Station of the Moscow City Healthcare Department during 2021–2025 as an example. Methods. The experience of implementing ultrasound monitoring, including the organization of staff training, methodological standardization, and telemedicine support, was summarized. A retrospective analysis of 25,420 ultrasound examinations performed by EMS teams during 2023–2025 was conducted. Descriptive statistics, growth-rate calculations, and Pearson’s chi-square test were used. Results. A multilevel training system was established, comprising accreditation programs, an in-house educational base, and remote support. A total of 1,207 employees were trained in emergency ultrasound skills. The number of ultrasound examinations increased more than twofold (χ² = 3119.4; p