title: Intraosseous line placement for antidote injection by first responders and receivers wearing personal protective equipment.
abstract: OBJECTIVE
  Early antidotal therapy may be lifesaving in hazardous materials victims. Intravenous line placement is difficult while wearing personal protective equipment (PPE). We assessed the ability of protected, experienced first responders and limited-experience first receivers to place intraosseous (IO) lines for antidote administration.
  
  
  METHODS
  Six first responders donned 4 (A, B, C, and D) and 12 first receivers donned 2 (C and D) United States Environmental Protection Agency PPE levels in random order and then placed IO lines in 1 of 4 anatomical sites in 12 anesthetized Spanish goats. Observers timed interventions until bolus injection of isotonic sodium chloride solution.
  
  
  RESULTS
  First responders placed IO lines successfully in 100% of cases. The median (interquartile range) times to completion (in seconds) were as follows: level A, 43.5 (23.0); B, 45.0 (29.0); C, 40.0 (15.0); D, 30.0 (17.0). First receivers placed IO lines successfully in 91% of cases. The median (interquartile range) times to completion (in seconds) were as follows: level C, 42.0 (19.5); D, 37.0 (11.0). There were no significant differences in time to completion among PPE levels (overall or pairwise) or between operator groups. Two (4%) of 48 line placements resulted in recognized extravasation due to penetration of the opposite cortex. Infusions were completed successfully.
  
  
  CONCLUSIONS
  Hazardous materials first responders and receivers can effectively place IO lines in a goat while wearing PPE. Intraosseous lines may facilitate earlier administration of antidotes in hazardous materials victims.
authors.affiliation: Division of Emergency Medicine and the South Texas Poison Center, Department of Surgery, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA. stephen.borron@ttuhsc.edu
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Borron
authors.forename: Juan C
authors.initials: JC
authors.lastname: Arias
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Philbeck
authors.forename: Patti
authors.initials: P
authors.lastname: Hass
authors.forename: Wayne
authors.initials: W
authors.lastname: Lawson
authors.forename: Diana
authors.initials: D
authors.lastname: Montez
authors.forename: Miguel
authors.initials: M
authors.lastname: Fernández
authors.forename: Inkyung
authors.initials: I
authors.lastname: Jung
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Gordon
mesh_terms: D000818:Animals; D000931:Antidotes / Q000008:administration & dosage*; D002983:Clinical Competence; D004634:Emergency Medical Technicians; D004867:Equipment Design; D006041:Goats; D006801:Humans; D006879:Hydroxocobalamin / Q000008:administration & dosage; D017148:Infusions, Intraosseous / Q000295:instrumentation*; D007267:Injections / Q000295:instrumentation; D007552:Isotonic Solutions / Q000008:administration & dosage; D011482:Protective Devices; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D000931:Antidotes; D007552:Isotonic Solutions; D012965:Sodium Chloride; D006879:Hydroxocobalamin