title: Basic-level emergency medical technician administration of fluids and glucose via enzyme-assisted subcutaneous infusion access.
abstract: BACKGROUND
  During disasters and mass-casualty incidents (MCIs), there may be insufficient numbers of advanced life support (ALS) providers to provide intravenous (IV) access to all patients requiring parenteral fluids and/or medications. Enzyme-assisted subcutaneous infusion (EASI) access, in which human recombinant hyaluronidase (HRH) augments subcutaneous fluid dispersion and absorption, may be useful when ALS resources are insufficient to meet intravascular access needs. The utility of the use of the EASI lies, in part, in its ease of placement by ALS personnel.
  
  
  OBJECTIVE
  The objectives of this study were to document the feasibility, comfort, and speed/degree of infused-glucose uptake through EASI lines placed by basic-level emergency medical technicians (EMT-Bs).
  
  
  METHODS
  Eighteen EMT-Bs instituted EASI access on each other. A total of 150 units (1 mL) of HRH were administered through the EASI line, followed by the administration of 250 mL of tracer-labeled D5W. Timed phlebotomy enabled gas chromatography/mass spectrometry characterization of glucose uptake. Enzyme-assisted subcutaneous infusion placement and comfort ratings were tracked and analyzed using non-parametric statistics and Fisher's Exact Test.
  
  
  RESULTS
  In all 18 subjects, EASI access required only one attempt and was rated by the EMT-Bs as easy to accomplish. Glucose was absorbed quickly (within five minutes) in all subjects. The rate of infusion was rapid (median 393 mL/hour) and was comfortable for the recipients (median pain score 1/10).
  
  
  CONCLUSIONS
  The use of EASI may be viable as a fast, simple, and reliable method for the administration of fluid and glucose by EMT-Bs.
authors.affiliation: Harvard Affiliated Emergency Medicine Residency Program, Boston, MA, USA.
authors.forename: Olanrewaju A
authors.initials: OA
authors.lastname: Soremekun
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Shear
authors.forename: Jay
authors.initials: J
authors.lastname: Connolly
authors.forename: Charles E
authors.initials: CE
authors.lastname: Stewart
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D008401:Gas Chromatography-Mass Spectrometry; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage*
chemical_list: D011994:Recombinant Proteins; D006821:Hyaluronoglucosaminidase; D005947:Glucose