The Israeli Defense Force experience with intraosseous access.
BACKGROUND
Obtaining vascular access is of paramount importance in trauma care. When peripheral venous access is indicated but cannot be obtained, the intraosseous route represents an alternative. The Bone Injection Gun (BIG) is the device used for intraosseous access by the Israeli Defense Force (IDF). The purpose of this study is to assess the success rate of intraosseous access using this device.


METHODS
The IDF Trauma Registry from 1999 to 2012 was searched for patients for whom at least 1 attempt at intraosseous access was made.


RESULTS
37 attempts at intraosseous access were identified in 30 patients. Overall success rate was 50%. No differences in success rates were identified between different care givers. Overall mortality was 87%.


CONCLUSIONS
The use of BIG in the IDF was associated with a low success rate at obtaining intraosseous access. Although inability to achieve peripheral venous access can be considered an indicator for poor prognosis, the high mortality rate for patients treated with BIG can also stand for the provider's low confidence in using this tool, making its use a last resort. This study serves as an example to ongoing learning process that includes data collection, analysis, and improvement, constantly taking place in the IDF.
The Trauma and Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Yaakov Dori Road, Ramat Gan, Israel 5262000.
Roy
R
Nadler
The Trauma and Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Yaakov Dori Road, Ramat Gan, Israel 5262000.
Sami
S
Gendler
The Trauma and Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Yaakov Dori Road, Ramat Gan, Israel 5262000.
Jacob
J
Chen
The Trauma and Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Yaakov Dori Road, Ramat Gan, Israel 5262000.
Gadi
G
Lending
The Trauma and Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Yaakov Dori Road, Ramat Gan, Israel 5262000.
Amir
A
Abramovitch
The Trauma and Combat Medicine Branch, Surgeon General's HQ, Israel Defense Forces, Yaakov Dori Road, Ramat Gan, Israel 5262000.
Elon
E
Glassberg
D061605:Administration, Intravenous / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation / Q000401:mortality / Q000706:statistics & numerical data*; D007557:Israel; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D012042:Registries; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000628:therapy; D014950:Wounds, Penetrating / Q000628:therapy; D055815:Young Adult