title: [Intraosseous access for fluid therapy in combat situations: use by Spanish military medical staff in Afghanistan].
abstract: OBJECTIVE
  To describe the Spanish military medical staff's experience with the use of intraosseous lines for fluid therapy in a combat zone.
  
  
  METHODS
  Descriptive study of 25 patients (30 needles). The patients were injured by firearms or explosive devices, or had multiple injuries, and were attended by Spanish military physicians in western Afghanistan (Herat) between March 2007 and June 2008.
  
  
  RESULTS
  The bone puncture was performed on 19 patients in prehospital settings. The remaining 6 patients underwent the procedure in the Spanish military hospital. All patients were men; the mean (SD) age was 26 (2.3) years. Most belonged to the Afghan National Army (64%) and had injuries caused by explosive devices (68%). The largest percentage of injuries involved the lower limbs (56%). A line could be inserted in 76% of the cases (100% at the military hospital). The first-choice site of puncture was the anterior tibial tuberosity. Fluids and medications were successfully administered through the intraosseous lines. No complications occurred during needle insertion, but 5 patients reported pain.
  
  
  CONCLUSIONS
  Our experience suggests that intraosseous access can provide an alternative to venous access for treating trauma patients in combat zones.
authors.affiliation: Escuela Militar de Sanidad, Hospital Universitario La Princesa, Madrid. r_navarro_suay@yahoo.es
authors.forename: R
authors.initials: R
authors.lastname: Navarro Suay
authors.forename: E
authors.initials: E
authors.lastname: Bartolomé Cela
authors.forename: A
authors.initials: A
authors.lastname: Hernández Abadía de Barbará
authors.forename: R
authors.initials: R
authors.lastname: Tamburri Bariain
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez Moro
authors.forename: J
authors.initials: J
authors.lastname: Olivera García
mesh_terms: D000328:Adult; D000346:Afghanistan; D001842:Bone and Bones; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel; D011677:Punctures; D013030:Spain; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*