Humeral head intraosseous access: Filling the military training gap

Abstract

Humeral head intraosseous (HHIO) infusion is the process of injecting fluids directly into the marrow of the humerus, or upper arm bone, to provide a non-collapsible entry point into the circulatory system. This technique provides fluids and medication quickly when intravenous (IV) access is not feasible in emergency situations. As of 2010, Tactical Combat Casualty Care guidelines recommend using intraosseous (IO) infusion in any resuscitation scenario where IV access is not feasible. The US Army Center for Pre-Hospital Medicine (CPHM) provides pre-deployment training to Roles I, II, and III medical providers. In addition, the CPHM provides training for deploying Forward Surgical Teams and en route care via the Critical Care Flight Paramedic Program. The Army’s Program of Instruction currently lacks an adequate simulation-based training model for the HHIO procedure and relies on live tissue training. The US Army Research Laboratory, Human Research and Engineering Directorate, Advanced Training and Simulation Division, developed a capability (i.e., Partial Task Trainer, or PTT) to train this procedure. This study assessed the usability of the PTT device for training on the IO procedure. Specifically, this paper seeks to identify statistically significant differences among the usability ratings of the PTT for paramedics and emergency medicine physicians.