The use of a powered device for intraosseous drug and fluid administration in a national EMS: a 4-year experience.

Background: Provide evidence of success rate and limitations of the prehospital use of a powered device for intraosseous (IO) bone infusion, the bone injection gun (BIG) for critical patients in whom peripheral intravenous (IV) access cannot be readily obtained.

Methods: This prospective study included all reports regarding the use of BIG in our national EMS during the study period. The BIG is a FDA and Israeli Health ministry approved device for IO cannulation. Starting April 2000, a new version was introduced to all ALS units. Simultaneously, our medical protocols were updated to include its use and mandatory reporting was initiated. Successful insertion was defined as "obtaining a good fluid flow through the needle without evidence of extravasation". This article presents an analysis of the data collected during this period.

Results: From May 2000 to June 2004, 189 patient encounters in which the BIG was employed met inclusion criteria and comprised the study group. Successful insertion on first attempt was achieved in 172 patients (91.0%). In two additional patients, a second attempt was successful. Forty-seven of the patients were below the age of 18 years (24.9%). One hundred ten patients (58.2%) were over 60 years of age. One hundred thirty-three were found without a palpable pulse (70.4%), and only 18 were found with a Glasgow coma scale of 9 or above. The cause was traumatic in 34 patients (18.0%).

Conclusion: The BIG provides an effective alternative IV access for critical patients in whom a peripheral IV line cannot be readily obtained in the prehospital setting.