En route intraosseous access performed in the combat setting

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Military Health

Background:

• Vascular access is critical for en route care during medical evacuation (MEDEVAC).
• Understanding current vascular access practices in combat settings is essential for optimizing patient care.

Purpose of the Study:

• To describe and compare vascular access practices utilized by en route care providers during military medical evacuations (MEDEVAC).
• To evaluate the success rates of different vascular access methods in a combat theater.

Main Methods:

• Retrospective cohort study of US military personnel records during Operation Enduring Freedom (Jan 2011-Mar 2014).
• Analysis of 1,267 MEDEVAC records, including 832 subjects with vascular access attempts.
• Comparison of peripheral intravenous (PIV) and intraosseous (IO) access success rates, survival, and clinical outcomes.

Main Results:

• Vascular access was attempted in 832 (66%) of MEDEVAC subjects.
• Peripheral intravenous (PIV) access had a 93% success rate (706/758).
• Intraosseous (IO) access, used as the sole method in 74 subjects, had an 85% success rate, with an overall IO placement success rate of 88%.

Conclusions:

• Intraosseous access is a viable and successful vascular access technique in the combat MEDEVAC setting.
• IO access accounted for approximately 12% of all vascular access in the studied MEDEVAC population.