A prehospital model of intraosseous infusion

Study objective: Before the implementation of an intraosseous infusion protocol by the City of Pittsburgh paramedics, we undertook a study to compare the establishment of a simulated intraosseous infusion in three different prehospital settings. The purpose of this study was to determine the time to establish an intraosseous infusion and the success rate at the scene and en route to the hospital using this model. Design: Prospective study. Setting: Three prehospital scenarios; classroom (scene); a medic unit traveling at 25 mph and making slow, steady turns (turns); and a medic unit traveling at 30 to 35 mph with sudden stops and starts (stop and go). Type of participants: Paramedics and emergency medicine residents. Measurements and main results: Successful placement of the IO needle was confirmed by the aspiration of marrow or the free flow of 5 to 10 mL of normal saline without extravasation into the surrounding tissue. The procedure was timed from skin entry to establishment of infusion. All participants were successful in establishing IO infusion, with 84.8% of infusions achieved in less than one minute in all settings. The scene had somewhat shorter mean and median times and a higher first-attempt success rate, but the differences between scenarios were not significant. Conclusion: Using a simulated model, IO access can be established successfully in the prehospital setting. The minimal time delay in establishing IO infusion may make it an appropriate technique for use at the scene or en route to the hospital.