12. EZ-IO

My List of the 16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic

The first time I put an IO in a small child, there was no choice between an IV and an IO. The child was in arrest. I had already dropped a tube and I now needed access. I couldn’t picture myself strapping on a tourniquet and probing for a tiny vein. I reached for the Jamshidi, found my landmark on the proximal tibia, and screwed it in. Pop! Just like that I was in. I amazed myself. The fluid ran fine. Some epi, some atropine, some CPR, and some lights and sirens, and two days later the kid’s name was in the obits. We did our best.

Not a week later, I did my second IO in a kid. Another arrest, although this was a little less traumatic – a kid with congenital disease, on feeding tubes, expected to die, died. The family still freaked and called 911. The fire department got there first and freaked and carried the kid out to us as we pulled into the curb. I get him on a small board in the back. Dropped the tube, reached for the old Jamshidi IO needle, and screwed it in. Only this time, something happened. When I tried to take the needle out, it wouldn’t budge. I had bent it when I screwed it in. All the short four minutes to the hospital I spend trying to yank the dam thing out while a firefighter did CPR, and my rider squeezed the ambu-bag, and the mother wailed from the front seat.

I put in a few more over the years, two successful and another one that bent. Since we got the EZ-IO, I thankfully haven’t had to use it yet on a child. I have done quite a number of EZ-IOs, usually almost all on elderly cardiac arrest patients with poor IV access. It’s great. Just drill and you are in. No misses. Every one has been in the proximal tibia. I’ve done two on living people, although both were in deep comas. I haven’t yet done one on an alert person and hope I never have to.

I am picking the EZ-IO as my twelfth biggest treatment change since I started as a medic because it has taken much of the anxiety out of what can be stressful situations.  Now admittedly the research shows that IV meds make no difference in cardiac arrest. Still, as a single medic it is nice to be able to get the skills done. Whether it is getting ROSC or simply fulfilling the requirements necessary to cease resuscitation on scene – an advanced airway, an IV or IO, 20 minutes of ACLS, — having the EZ-IO in the kit as an IV backup is a big help.

While on the subject of the EZ-IO, there was an interesting study in the Annals of Emergency Medicine that came out last year comparing a tibial EZ-IO with a humeral EZ-IO with a peripheral IV during cardiac arrest. The tibial EZ-IO had the highest first attempt success rate (91%) with the lowest dislodgement rate, but the peripheral IV was capable of delievering twice the amount of fluid as the IOs.

Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a randomized controlled trial.

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16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic

13. Permissive Hypotension
14.Expanded Medication Routes, Less IV Emphasis
15. Narrower Use of Narcan
16. Increased Standing Orders

1 Comment

  • Mack505 says:

    I’ve done one on a very sick conscious teenager. It was a humeral head insertion. Scariest part was that he said it didn’t hurt much. (The infusion is supposed to hurt like h*ll.). He was one sick kid, but he lived.

    I hope I never get to do that one again.

    I agree, the EZ-IO is a wonderful tool.

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