FEASIBILITY OF STERNAL INTRAOSSEOUS ACCESS BY EMERGENCY MEDICAL TECHNICIAN STUDENTS

Abstract

Objective. Emergency medical technician–basic (EMT-B) providers are not trained to establish vascular or intraosseous (IO) access on critically ill patients. This study was conducted to examine the feasibility of training EMT-B students to correctly place a commercial sternal IO infusion device (FAST-1). Methods. Twenty-nine EMT-B students attended a two-hour training session. Subjects were subsequently tested in FAST-1 application using a modified resuscitation mannequin permitting IO needle deployment. Two observers assessed correct IO application andtechnique. Results were analyzed using descriptive statistics (binomial proportions andmedians with 95% confidence intervals). Inter-rater agreement of observations was evaluated using kappa statistics andintraclass correlation coefficients (ICCs). Results. Inter-rater agreement ranged from fair to excellent (kappa = 0.37–1.00) for all parameters except sternal notch identification (kappa = −0.03). Reliabilities of elapsed times were good (ICC = 0.83, 0.31). Correct identification of the sternal notch was accomplished by 28 of 29 students (96.6%; 95% CI: 82.2–99.9%). Correct application of the IO target patch was achieved by 29 of 29 (100.0%; 88.1–100.0%). First-attempt successful IO needle deployment was achieved by 16 of 29 (55.2%; 35.7–73.6%). Overall successful IO needle deployment within four attempts was achieved by 27 of 29 (93.1%; 77.2–99.2%). The protective dome was correctly applied by 27 of 29 (93.1%; 77.2–99.2%). The median time to needle deployment was 27.5 seconds (95% CI: 24–31). The median time to dome placement was 50 seconds (95% CI: 42–55). Conclusions. EMT-B students with minimal training demonstrated limited success with applying a commercial sternal IO device. Clinical application by EMT-Bs on critically ill patients may be possible with more intensive training.