title: Feasibility of sternal intraosseous access by emergency medical technician students.
abstract: OBJECTIVE
  Emergency medical technician-basic (EMT-B) providers are not trained to establish vascular or intraosseous (IO) access on critically ill patients. This study was conducted to examine the feasibility of training EMT-B students to correctly place a commercial sternal IO infusion device (FAST-1).
  
  
  METHODS
  Twenty-nine EMT-B students attended a two-hour training session. Subjects were subsequently tested in FAST-1 application using a modified resuscitation mannequin permitting IO needle deployment. Two observers assessed correct IO application and technique. Results were analyzed using descriptive statistics (binomial proportions and medians with 95% confidence intervals). Inter-rater agreement of observations was evaluated using kappa statistics and intraclass correlation coefficients (ICCs).
  
  
  RESULTS
  Inter-rater agreement ranged from fair to excellent (kappa = 0.37-1.00) for all parameters except sternal notch identification (kappa = -0.03). Reliabilities of elapsed times were good (ICC = 0.83, 0.31). Correct identification of the sternal notch was accomplished by 28 of 29 students (96.6%; 95% CI: 82.2-99.9%). Correct application of the IO target patch was achieved by 29 of 29 (100.0%; 88.1-100.0%). First-attempt successful IO needle deployment was achieved by 16 of 29 (55.2%; 35.7-73.6%). Overall successful IO needle deployment within four attempts was achieved by 27 of 29 (93.1%; 77.2-99.2%). The protective dome was correctly applied by 27 of 29 (93.1%; 77.2-99.2%). The median time to needle deployment was 27.5 seconds (95% CI: 24-31). The median time to dome placement was 50 seconds (95% CI: 42-55).
  
  
  CONCLUSIONS
  EMT-B students with minimal training demonstrated limited success with applying a commercial sternal IO device. Clinical application by EMT-Bs on critically ill patients may be possible with more intensive training.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Miller
authors.forename: Guy
authors.initials: G
authors.lastname: Guimond
authors.forename: David P
authors.initials: DP
authors.lastname: Hostler
authors.forename: Thomas
authors.initials: T
authors.lastname: Platt
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods; D004634:Emergency Medical Technicians / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017148:Infusions, Intraosseous / Q000379:methods*; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D013249:Sternum; D013334:Students