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Prehospital intraosseous access in combat trauma: a retrospective registry analysis
Ofer Almog1,2, Cole D Bendor3,2, Shaul Gelikas3,4
1Medical Corps, Israel Defense Forces, Tel Aviv-Yafo, Tel Aviv District, Israel ofer18181@gmail.com.
Introduction:
Intraosseous (IO) devices have become a vital tool in trauma care for establishing rapid circulatory access, particularly in emergency and prehospital environments where peripheral vascular access may be delayed or unsuccessful. In modern combat settings, detailed data on prehospital IO use, indications and outcomes remain limited. We aimed to describe the indications and success rates of prehospital IO access in combat trauma casualties treated by military advanced life support providers during the 2023-2024 Israel-Gaza conflict, and to report any acute complications documented in the prehospital and early hospital phases.
Study Objective:
To evaluate the use and success rate of IO access in trauma casualties treated by military advanced life support providers during the 2023-2024 Israel-Gaza conflict.
Methods:
This retrospective study analysed data from the Israel Defense Forces Trauma Registry and the Israeli National Trauma Registry. All cases involving prehospital IO access from 27 October 2023 to 27 November 2024 were included. Variables included demographic characteristics, injury patterns, IO device type, insertion sites, success rates, indications and outcomes.
Results:
83 casualties were included. Most had severe penetrating injuries (94%) and presented with signs of hypovolemic shock (82%). IO access was predominantly used for volume resuscitation with blood products (84%), including low-titre group O whole blood transfusion (67%). The proximal tibia was the most common insertion site (77%). NIO devices were used in most cases with high first-attempt success; overall IO insertion success was 85%. No major acute complications related to IO access were documented.
Conclusion:
In this cohort of modern combat casualties, intraosseous access was frequently used to enable blood-product resuscitation in severely injured, profoundly shocked casualties, with high first-attempt and overall insertion success and no major acute complications documented. These findings support IO as a feasible and reliable option for circulatory access in austere environments.
