Intraosseous access in the military operational setting

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Military Medicine

Background:

• Circulatory access is challenging in military settings due to hypovolemia and limited responder experience.
• Rapid access is critical for injuries causing catastrophic hemorrhage, like traumatic amputations.
• The EZ-IO and FAST1 intraosseous devices have been used by Defence Medical Services since 2006.

Purpose of the Study:

• To evaluate the functionality and complication rates of EZ-IO and FAST1 intraosseous devices in an operational military environment.
• To assess the real-world performance of these devices in emergency trauma care.

Main Methods:

• A prospective observational study was conducted from March to July 2011 at Camp Bastion, Afghanistan.
• Data on 195 intraosseous devices (149 EZ-IO, 46 FAST1) in 117 patients were recorded.
• Device functionality (successful flush) and any encountered problems were documented.

Main Results:

• An overall success rate of 84.7% was achieved, with 111 out of 117 devices functioning.
• Device failure occurred in 17 instances, with the humerus being a more prevalent site for failure.
• Inability to flush the device was the leading cause of failure, followed by mechanical issues. Two complications involved device breakage upon removal.

Conclusions:

• Intraosseous devices demonstrated success rates comparable to existing literature, even after a median insertion time of 32 minutes.
• No significant differences in device performance were observed between different insertion sites.
• Further research is recommended to investigate the long-term complications associated with intraosseous device use.