Adult Intraosseous Access by Advanced EMTs: A Statewide Non-Inferiority Study

Area of Science:

• Emergency Medicine
• Prehospital Care
• Medical Device Access

Background:

• Intraosseous (IO) access is a critical alternative to intravenous access in prehospital emergencies.
• Establishing peripheral IV access can be challenging in critically ill patients.
• Paramedics have historically been the sole providers of adult IO access.

Purpose of the Study:

• To compare the success rates of adult IO access procedures performed by Advanced Emergency Medical Technicians (AEMTs) versus Paramedics.
• To evaluate the non-inferiority of AEMT-performed IO access in the prehospital setting.

Main Methods:

• Retrospective analysis of 543 adult patient encounters with IO insertion attempts in Vermont EMS from January 2013 to November 2015.
• Comparison of successful IO insertion proportions between AEMTs and Paramedics using Chi-Squared and non-inferiority tests.

Main Results:

• No significant difference in successful IO access rates between AEMTs (95.2%) and Paramedics (95.6%).
• The observed difference was within the pre-specified non-inferiority margin (95% CI: -4.2, 3.2).

Conclusions:

• AEMTs achieve comparable success rates to Paramedics in establishing adult IO access.
• The study provides evidence supporting the expansion of AEMT scope of practice to include adult IO access procedures.