title: A review of the evolution of intraosseous access in tactical settings and a feasibility study of a human cadaver model for a humeral head approach.
abstract: In the tactical setting, intraosseous (IO) access has become popular to treat hemorrhagic shock when peripheral intravenous access is difficult or impractical. The traditional sites most commonly used by combat medics, corpsmen, and Pararescuemen (PJs) include the sternum and tibial tuberosity. Recent studies have shown that the humeral head (HH) is an appropriate and effective access site for IO infusion and fluid resuscitation in the clinical setting. In this procedural feasibility study, we assessed the ability of 26 U.S. Air Force PJs to perform HH IO placement on fresh, unfixed human cadavers over two consecutive cadaver lab training sessions. Following a formal didactic session, which highlighted proper patient positioning and technique, the PJs were instructed to attempt to place an IO needle using both a drill and manual driver. Once performed, correct placement was reviewed by a physician and confirmed by aspiration of bone marrow. Rates of success were calculated on first and second pass. First pass success rates were 96% and 90.5% for the drill and driver, respectively. Both devices achieved 100% success by the second pass. Military field personnel would benefit from a HH approach, especially in the care and management of patients of explosive injuries.
authors.affiliation: Departments of Neurosurgery and Radiation Oncology, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rush
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Long Island Jewish Medical Center, 300 Community Drive, Manhasset, NY 11030.
authors.forename: Jason
authors.initials: J
authors.lastname: D'Amore
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Long Island Jewish Medical Center, 300 Community Drive, Manhasset, NY 11030.
authors.forename: Eric
authors.initials: E
authors.lastname: Boccio
mesh_terms: D000328:Adult; D002102:Cadaver; D005240:Feasibility Studies; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D058430:Humeral Head; D017148:Infusions, Intraosseous / Q000295:instrumentation / Q000379:methods*; D008889:Military Personnel; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D013647:Task Performance and Analysis; D014481:United States; D000067398:War-Related Injuries / Q000150:complications