title: Intraosseous access in the military operational setting.
abstract: BACKGROUND
  In an operational military environment, circulatory access can prove difficult for a variety of reasons including profound hypovolaemia, and limited first responder experience. With many injuries that cause catastrophic haemorrhage, such as traumatic limb amputations, circulatory access is needed as quickly as possible. Since 2006, the Defence Medical Services have been using the EZ-IO and FAST1 devices as a means of obtaining circulatory access.
  
  
  METHODS
  A prospective observational study was conducted between March and July 2011 at the Emergency Department, Camp Bastion, Afghanistan. All patients with an intraosseous device had data recorded that included if the device successfully flushed (functionality) and if any problems were encountered.
  
  
  RESULTS
  117 patients presented with a total of 195 devices: 149 were EZ-IO (76%) and 46 were FAST1 (24%). Functionality was recorded for 111 (57%), with 17 failing to function, yielding an overall success rate of 84.7%. Device failure was observed to be more prevalent in the humerus; inability to flush the device was the leading cause, followed by mechanical failure. There were 2 complications, device breaking on removal being the reason for both.
  
  
  CONCLUSIONS
  The devices in the study were tested for a period of time following insertion (median 32 minutes), and still the success rates mirror those found in the literature. Observed differences between sites were not found to be significant with confidence intervals overlapping. Further work is proposed to investigate the long-term complications of intraosseous devices.
authors.forename: J
authors.initials: J
authors.lastname: Vassallo
authors.forename: S
authors.initials: S
authors.lastname: Horne
authors.forename: J E
authors.initials: JE
authors.lastname: Smith
mesh_terms: D055826:Afghan Campaign 2001-; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D006811:Humerus; D017148:Infusions, Intraosseous / Q000295:instrumentation*; D008887:Military Medicine; D008889:Military Personnel; D011446:Prospective Studies; D012151:Resuscitation / Q000295:instrumentation*; D013977:Tibia; D062666:Vascular Access Devices