Intraosseous

[P_Instructor]

IV's rule the roost here.

[mleiser]

I'm a paramedic in New York and here, for adults, IO is only allowed for an arrest. In fact, I used one this morning on an arrest. I noticed everyone is speaking statistics regarding how many are used. In NY, because of our protocol, it isn't that many. Nevertheless, my question is, other than the possibility of some folks not having the skill to do an IV, what is wrong with an IO? It gets done quickly and it works. Especially on an arrest. Just my two cents.

[Just Plain Ruff]

I'm a paramedic in New York and here, for adults, IO is only allowed for an arrest. In fact, I used one this morning on an arrest. I noticed everyone is speaking statistics regarding how many are used. In NY, because of our protocol, it isn't that many. Nevertheless, my question is, other than the possibility of some folks not having the skill to do an IV, what is wrong with an IO? It gets done quickly and it works. Especially on an arrest. Just my two cents.

No one is saying anything is wrong with an IO.

[rock_shoes]

I work targeted ALS in an area serving 2.5 million people with a total of 8 ALS units in the entire area (as in 3.2 ALS ambulances per 1 million population). Even working within a high exposure system, I typically only use the IO one out of every twelve shifts.

If the numbers presented regarding IO usage within this particular system are correct this services IO usage policy and IV skill maintenance are in dire need of review. Are medics in this area simply using the IO because its easy and a fun toy? If they're using IO's so frequently are they at least pre-dosing some lidocaine through the IO before the initial rapid flush (excluding those placed in codes of course)?

[Just Plain Ruff]

I work targeted ALS in an area serving 2.5 million people with a total of 8 ALS units in the entire area (as in 3.2 ALS ambulances per 1 million population). Even working within a high exposure system, I typically only use the IO one out of every twelve shifts.

If the numbers presented regarding IO usage within this particular system are correct this services IO usage policy and IV skill maintenance are in dire need of review. Are medics in this area simply using the IO because its easy and a fun toy? If they're using IO's so frequently are they at least pre-dosing some lidocaine through the IO before the initial rapid flush (excluding those placed in codes of course)?

I am not going to be able to answer any of those questions for you Rock_shoes, my numbers are strictly from a conversation with the nurse manager and I have no info from the EMS systems in the area.

But I do have a fire station that houses 2 ambulances in the station that I might just drop by and strike up a conversation. Discuss it with them in passing. If they are like any other EMS staff, they like to talk about their jobs with a out of stater who just moved up here and actually might want to do some part time work in the area. Good questions to ask.

Now if I can only get my registry back.

[paramedicmike]

Nevertheless, my question is, other than the possibility of some folks not having the skill to do an IV, what is wrong with an IO? It gets done quickly and it works.

This addresses a much larger issue that's tangential to this particular discussion but is still important.

There is a place for IO access. It is not appropriate for every patient or even most patients. If there is a skill issue and providers are choosing to place an IO in place of an IV simply because their IV placement skills are deficient then there is a larger systemic and educational problem that needs to be addressed.

I believe the original claim made by the provider in the good Captain's OP isn't as accurate as she claimed and has been addressed in follow up discussion.

[Just Plain Ruff]

This addresses a much larger issue that's tangential to this particular discussion but is still important.

There is a place for IO access. It is not appropriate for every patient or even most patients. If there is a skill issue and providers are choosing to place an IO in place of an IV simply because their IV placement skills are deficient then there is a larger systemic and educational problem that needs to be addressed.

I believe the original claim made by the provider in the good Captain's OP isn't as accurate as she claimed and has been addressed in follow up discussion.

Yeah, Mike, The three other hospitals that I had access to representatives from, all say that their numbers are far fewer than what were quoted originally. And these hospitals all get patients from the EMS Systems that the original hospital gets, probably more so than the original hospital.

[scott33]

I'm a paramedic in New York and here, for adults, IO is only allowed for an arrest.

The protocol is currently being revised to allow IOs in patients in decompensated shock with the addition of 2% lidocaine bolus, prior to infusion, if required.

Edited October 29, 2013 by scott33