Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T05:20:55.387Z Has data issue: false hasContentIssue false

Paramedic Evaluation of Adult Intraosseous Infusion System

Published online by Cambridge University Press:  28 June 2012

Judy Findlay
Affiliation:
Pyng Medical Corp., Vancouver, British Columbia Canada
David L. Johnson
Affiliation:
Pyng Medical Corp., Vancouver, British Columbia Canada
Andrew J. Macnab*
Affiliation:
University of British Columbia, Department of Pediatrics, Vancouver, British Columbia Canada; British Columbia Ambulance Service, Vancouver, British Columbia Canada
David MacDonald
Affiliation:
Paramedic Academy, Justice Institute of British Columbia
Ryan Shellborn
Affiliation:
Paramedic Academy, Justice Institute of British Columbia
Lark Susak
Affiliation:
Magnet Management Ltd., Burnaby, British Columbia Canada
*
Distinguished Scholar in Residence Peter Wall Institute for Advanced Studies University Centre University of British Columbia 6331 Crescent Road Vancouver, BC V6T 1Z2 CANADA E-mail: [email protected]

Abstract

Introduction:

The First Access for Shock and Trauma (FAST 1) Sternal Intraosseous (IO) System is a vascular access device designed as an alternative to peripheral or central intravenous (IV) cannulation for the treatment of critically ill and injured adults. During the development of the device, key objectives included safety, speed of insertion, and ease of use with minimal training. This study evaluated these characteristics.

Methods:

Ten experienced paramedics participated in a 90-minute training program for the use of the FAST 1 System at the Paramedic Academy of the Justice Institute of British Columbia. Then, the paramedics used thesystem in three simulated prehospital scenarios and evaluated the ease of use and compatibility of the training method with current practice using a 10-centimeter (cm) (3.94 inches (in)), visual analog scale.

Results:

The duration of the procedure from opening the package to initiation of fluid flow ranged 52–127 seconds (mean = 92 ±32 seconds). Placement accuracy was excellent, with a mean displacement of 2 mm (0.08 in) and 1 mm (0.04 in) in the vertical and horizontal planes, respectively. The paramedics rated the system highly in all areas. They considered the training “straight forward” and “comprehensive”. The possibility for interference between the IO system and cervical collars was reported, and several suggestions to remedy this and achieve other improvements were made.

Conclusions:

Placement of the FAST 1 is fast, accurate, and easy to use. Paramedics had useful input concerning the design of the product.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Border, JR, Lewis, FR, Aprhamian, C, Haller, JA, Lenworth, MJ, Luterman, A: Panel: Prehospital trauma care–Stabilize or scoop and run. J Trauma 1983;23(8):708711.Google Scholar
2.Stapczynski, JS: Fluid resuscitation in traumatic hemorrhagic shock: Challenges, controversies and current clinical guidelines. Emerg Med Reports 1994:1515(25):241250.Google Scholar
3.Mattox, KL, Allen, MK: Penetrating wounds of the thorax. Injury 1986;17(5):313317.Google Scholar
4.Martin, RR, Bickell, WH, Pepe, PE, Burch, JM, Mattox, KL: Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: A preliminary report. J Trauma 1992;33(3):354361.Google Scholar
5.Bickell, WH, Wall, MJ Jr., Pepe, PE, Martin, RR, Ginger, VF, Allen, MK, Mattox, KL: Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331(17):11051109.Google Scholar
6.McSwain, GR, Garrison, WB, Artz, CP: Evaluation of resuscitation from cardiopulmonary arrest by paramedics. Ann Emerg Med 1980;9(70):341345.Google Scholar
7.Smith, JP, Bodai, BI, Hill, AS, Frey, CF: Prehospital stabilization of critically injured patients. A failed concept. J Trauma 1985;25(1):6570.Google Scholar
8.Bodai, BI, Smith, JP: Mistakes in treatment of accident cases before reaching the hospital. Injury 1987;18:18.Google Scholar
9.Donovan, PJ, Cline, DM, Whitley, TW, Foster, C, Outlaw, M: Prehospital care by EMTs and EMT-1s in rural setting: Prolongation of scene times by ALS procedures. Ann Emerg Med 1989;18:495499.Google Scholar
10.O'Gorman, M, Trabulsy, P, Pilcher, DB: Zero-time prehospital IV. J Trauma 1989;29:8485.Google Scholar
11.Johnson, GS, Guly, HR: The effect of pre-hospital administration of intravenous nalbuphine on on-scene times. J Accid Emerg Med 1995;12(1):2022.CrossRefGoogle ScholarPubMed
12.Gervin, AS, Fischer, RP: The importance of prompt transport in salvage of patients with penetrating heart wounds. J Trauma 1982;22(6);443448.Google Scholar
13.Kramer, GC: Intraosseous Resuscitation Progress Report. Department of Human Physiology. University of California, Davis, March 1990.Google Scholar
14.Lewis, FR: Prehospital intravenous fluid therapy: Physiologic computer modeling. J Trauma 1986;26(9):804811.Google Scholar
15.Jones, SE, Nesper, T, Alcouloumre, E: Prehospital intravenous line placement: A prospective study. Ann Emerg Med 1989;18:244246.CrossRefGoogle ScholarPubMed
16.Dubick, MA, Holcom, JB: A review of intraosseous vascular access: Current status and military application. Mil Med 2000;165:552559.Google Scholar
17.Calkins, MD, Fitzgerald, G, Bentley, TB, Burris, D: Intraosseous infusion devices: A comparison for potential use in special operations. J Trauma 2000;48(6):10681074.Google Scholar
18.Fiser, DH: Intraosseous infusion. Current Concepts 1990;322(22):15791581.Google ScholarPubMed
19.Glaeser, PW, Hellmich, TR, Szewczuga, D, Losek, JD, Smith, DS: Five-year experience in prehospital intraosseous infusions in children and adults. Ann Emerg Med 1993;22(7):1217.Google Scholar
20.Guy, J, Haley, K, Zuspan, SJ: Use of intraosseous infusion in the pediatric trauma patient. J Ped Surg 1993;28(2):158161.Google Scholar
21.Hodge, L: Intraosseous infusions: A review. Ped Emerg Care 1985;1(4):215218.CrossRefGoogle ScholarPubMed
22.Miccolo, MA: Intraosseous infusion. Crit Care Nurse 1990;10(10):3546.Google Scholar
23.Halvorson, L, Bay, BK, Perron, PR, Gunther, RA, Holcroft, JW, Blaisdell, W, Kramer, GC: Evaluation of an intraosseous infusion device for the resuscitation of hypovolemic shock. J Trauma 1990;30(6):652659.Google Scholar
24.Macnab, A, Christensen, J, Findlay, J, Horwood, B, Johnson, D, Jones, L, Phillips, K, Pollack, C Jr., Robinson, DJ, Rumball, C, Stair, T, Tiffany, B, Whelan, M: A new system for sternal intraosseous infusion in adults. Prehosp Emerg Care 2000;4(2):173177.CrossRefGoogle ScholarPubMed
25.MacGregor, DF, Macnab, AJ: Intraosseous fluids in emergencies. Pediatrics 1990:85:386387.CrossRefGoogle ScholarPubMed
26.Rogers, SN, Benumof, JL: Intraosseous infusions. Proc Emerg Med 1985:339343.Google Scholar
27.Hubble, MW, Trigg, DC: Training prehospital personnel in saphenous cut down and adult intraosseous techniques. Prehosp Emerg Care 2001;5(2):181189.CrossRefGoogle Scholar