IO Versus IV Access While Wearing Personal Protective Equipment in a HazMat Scenario

Abstract

Objective. Determine the time difference obtaining intraosseous (IO) versus intravenous (IV) access while wearing personal protective equipment (PPE) in simulated HazMat scenarios. Methods. Twenty-two EMT-P providers established anterior tibial IO access using the EZ-IO® system androutine antecubital IV access in three mannequin andPPE HazMat scenarios: 1) provider andmannequin not in PPE, 2) only provider in Level C PPE, and3) provider andmannequin both wearing Level C PPE. Primary outcome measures were the average time in seconds for skin access, vascular access, andfluid infusion with each method in these configurations. Results For the provider andmannequin not in PPE condition, needle to skin time favored the IV (6.2 vs. 9.3 seconds; p < 0.001). whereas vascular access time (12.8 vs. 36.3 seconds; p < 0.001) andfluid infusion time (26.2 vs. 36.5 seconds; p = 0.02) favored the IO approach. For the provider in PPE andmannequin not in PPE condition, needle to skin times were similar for IO andIV (10.4 vs. 12.7 seconds; p = 0.591), whereas vascular access time (14.0 vs. 46.0 seconds; p < 0.001) andfluid infusion time (28.3 vs. 45.7 seconds; p < 0.001) both favored the IO approach. With the provider andmannequin in PPE, needle to skin time (12.7 vs. 24.9 seconds; p < 0.001), vascular access time (16.9 vs. 62.7 seconds; p < 0.001), andfluid infusion time (29.5 vs. 66.1 seconds; p < 0.001) all favored the IO approach. Fluid infusion times for the provider not in andin PPE (26.2 vs. 28.3 seconds; p < 0.05) with the mannequin not in PPE revealed no significant time burden associated with using the EZ-IO® device with the provider in PPE. Conclusions.Overall, the EZ-IO® system under HazMat conditions provides vascular access andfluid more quickly than standard intravenous access. When providers andmannequins were both in PPE, the time differential between IO andIV access was the greatest, favoring the IO approach. Donning PPE did not hinder the providers' use of the EZ-IO® device andmay be useful for obtaining vascular access when wearing PPE.

Key words:

• intraosseous
• intravenous access
• PPE
• HazMat