# TnECHO vs Firstline

The clearest difference is rating: Firstline at 4.9 against TnECHO's 3.2. Firstline also leads on update cadence (fortnightly vs every 3 months) and ratings volume (645 vs 5). TnECHO's advantage is iOS requirement (7.1 vs 17.0). On price, ads, in-app purchases and monetization model there is nothing between them.

Both are free to download. Neither carries in-app purchases, so what you see is what you pay.

Firstline holds the better App Store score, 4.9 against 3.2. That said, the two scores are not equally well evidenced: Firstline has 645 ratings behind it against 5, so its average is the more settled of the two. Written reviews point the same way: 80% of TnECHO's written reviews are positive against 89% of Firstline's.

TnECHO ships an update every 3 months, Firstline fortnightly. The most recent releases landed on October 23, 2026 and October 26, 2026 respectively.

## The numbers

| Metric | TnECHO | Firstline |
| --- | --- | --- |
| Price | Free | Free |
| Rating | [3.2 (5 ratings)](https://appshunter.io/ios/app/tnecho/id522700359/reviews) | **[4.9 (645 ratings)](https://appshunter.io/ios/app/firstline-clinical-decisions/id921339941/reviews)** |
| Number of ratings | 5 | **645** |
| Positive reviews | 80.0% of reviews | **89.5% of reviews** |
| In-app purchases | No | No |
| Ads | No | No |
| Update frequency | Every 3 months | **Fortnightly** |
| Monetization | Free | Free |
| Size | 156 MB | 3 MB |
| Requires iOS | **7.1** | 17.0 |
| Devices | **iPhone, iPad, iPod** | iPhone, iPad |
| Age rating | 4+ | 17+ |
| Developer | [The Hospital for Sick Children](https://appshunter.io/developer/444728983) | [Spectrum Mobile Health Inc.](https://appshunter.io/developer/1072846527) |

## What reviewers say

### TnECHO

[App page](https://appshunter.io/ios/app/tnecho/id522700359)

This application supports neonatologists in training by providing visual guides for neonatal echocardiography. It includes videos and loops to familiarize users with basic views and anatomical structures, aiding self-directed learning in the NICU setting.

**Highlights:** Probe position videos, 2D echo loops, Color Doppler loops, Anatomical structure labeling, Self-directed learning aid, NICU decision support

**In-app purchases:** none


### Firstline

[App page](https://appshunter.io/ios/app/firstline-clinical-decisions/id921339941)

Provides healthcare professionals with interactive, point-of-care guidance for optimal patient treatment. Access customizable protocols, antimicrobial stewardship, and infection control information. Updates are rapid and it functions offline.

**Highlights:** Antimicrobial Stewardship guidelines, Infection Prevention & Control protocols, Customizable for healthcare organizations, Antimicrobial formulary information, Pathogen and antibiogram data, Offline functionality

**Features:** macOS Compatibility, Vision Pro support

**In-app purchases:** none

**What reviewers like**

- 👍 Easy to use and intuitive navigation
- 🎨 Beautiful and visually pleasing design
- 📚 Excellent reference resource for medical professionals
- ⚡ Quick and convenient point-of-care tool
- 🏥 Highly useful for clinical decision-making

**What reviewers complain about**

- 🐛 App fails to load or progress past loading screen
- 🐛 Frequent crashes after updates
- ⚠️ Stability issues requiring reinstallation
- ❌ Unresponsive membership request process

**Reported bugs**

- App will not progress past loading screen
- App crashes constantly on startup after updates
- Requires uninstall and reinstall to resolve crashes
- Crashes return after a few hours or days

**Requested features**

- Treatment duration guidelines for pathogens
- Regional data for additional areas (e.g., Southern Ontario/Hamilton/Toronto)
- More specific treatment duration information


## Frequently asked questions

### Is TnECHO free?

TnECHO is free to download, with no in-app purchases.

### Is Firstline free?

Firstline is free to download, with no in-app purchases.

### Which has better reviews, TnECHO or Firstline?

Firstline is rated higher. TnECHO averages 3.2 out of 5 from 5 ratings, while Firstline averages 4.9 from 645 ratings.

### Do TnECHO or Firstline have ads?

Neither TnECHO nor Firstline shows ads.

### Which is updated more often, TnECHO or Firstline?

TnECHO ships an update every 3 months, and Firstline fortnightly. Most recently, TnECHO was updated on October 23, 2026 and Firstline on October 26, 2026.

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*Compared by [AppsHunter](https://appshunter.io/) from daily US App Store data. Review summaries are generated from verbatim App Store reviews.*