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Point-of-care ultrasound (POCUS) is a potentially valuable tool in the out-of-hospital setting, offering paramedics critical diagnostic information in real time. Lung ultrasound, specifically, holds great promise for improving the management of respiratory distress, a common emergency encountered by paramedics. Despite its potential, the use of POCUS in the out-of-hospital setting is currently limited by factors such as a lack of training, supervision and resource availability. Tele-ultrasound, which allows remote experts to guide paramedics in real time, may help overcome these barriers. This study aimed to assess the acceptability of tele-ultrasound among specialist paramedic trainees and explore factors influencing its potential adoption into paramedic practice. A mixed-methods interventional study was conducted. An online learning module and workshop was provided prior to the intervention. Participants then performed tele-guided lung ultrasound scans on healthy volunteers, with remote guidance provided by sonographers. Acceptability was measured using the Usage Rating Profile-Intervention Revised (URP-IR) survey. Survey data was complemented by qualitative insights from free-text responses through a descriptive content analysis approach. Nine participants completed the study with acceptability scores high in this small sample (mean score 5.33/6). Feasibility was also rated favourably, with participants expressing confidence in the technology's diagnostic potential. Content analysis revealed concerns about system support, particularly regarding equipment reliability and communication. Tele-ultrasound guidance has potential to enhance paramedic diagnostic capabilities. Whilst the intervention was well received, efforts to optimise remote communication protocols and address technical barriers are essential for wider adoption.