Use of intraosseous access by prehospital emergency medical services

Since 2005 the European Resuscitation Council (ERC) has recommended an intraosseous access as an early alternative for difficult vein situations in the guidelines for emergency medical services. But how does the theory succeed in routine practice? Using a survey of rescue assistants and physicians, the authors found that the intraosseous infusion technique is still a rarity in the Berlin emergency medical service and therefore presumably nationwide, 5 years after a revision of its importance. Within a preclinical prospective observational study with before and after analyses, it was shown that use of an intraosseous access according to the guidelines can be reasonably and efficiently integrated into treatment algorithms of preclinical emergency medical services by the use of modern products. During a period of 10.5 months an intraosseous access was established in a very short time in 100 patients with no complications and independent of the experience of the operator, because the timely placement of a peripheral venous access was not possible. This corresponds to an average frequency of 2.2 per week or 9.5 per month and a proportion of 4.5% of the total patient collective or 22.7% of patients estimated to be in a life-threatening situation. The application of the intraosseous technique increased accordingly by a factor of 7 to 27.2 per 1,000 alarm calls by the implementation of the guidelines. Intraosseous access is a simple aid to minimize the therapy-free time even with limited personnel resources. Its use in preclinical emergency medical services seems, however, to be more of a rarity than a standard and does not therefore correspond to the evidence-based recommendations of the professional societies.