The role of intraosseous vascular access in the out-of-hospital environment (resource document to NAEMSP position statement).

Thousands of critically ill emergency patients are treated in the out-of-hospital setting in the United States every year. In many patients intravenous (IV) therapy cannot be initiated because of inadequate access to peripheral veins. In some cases, this lack of vascular access may limit benefit of medications because of late administration.[1] Both speed and overall success of vascular access are important when evaluating potential methodologies for their use in the out-of-hospital environment. Insertion of an IV cannula has been reported to require substantial time in the prehospital environment, with a recent study reporting an average successful intravenous line placement time of 4.4+/-2.8 minutes.[2] In critically ill pediatric patients, vascular access may present substantial difficulties to the provide.[3] Intraosseous access may provide a significant time saving which may benefit many critically ill patients, both by decreasing the time to achieve access and by decreasing the time to administration of indicated medications.[4] Achieving rapid administration of medications may facilitate the care of critically ill patients.[1] Devices are now available that permit rapid, accurate access to the intraosseous space. Recent changes in the American Heart Association's resuscitation guidelines state that the intraosseous route should be the first alternative to difficult or delayed intravenous access.[5] With these considerations, the role of intraosseous vascular access in the out-of-hospital environment should be reemphasized.