Air Evacuation Research Articles

Adaptive Aerial Grasping and Perching With Dual Elasticity Combined Suction Cup

To perch on or grasp the objective surface using the suction cup-based manipulator, the precise contact control is commonly required. Improper contact angle or insufficient contact force may cause failure. To enhance the tolerance to flight control insufficiency, a suction cup that comprises an inner soft cup and an outer firm cup to facilitate its engagement without reducing the adhesion stiffness is investigated. The soft cup is adaptable to the angular error induced by the multicopter and the resulting adhesion force can draw the firm cup and correct the angular error between the firm cup and the surface. These effects increase the engagement rate and reduce the dependence on precise control. The outer firm cup is devoted to providing a large adhesion force and a stiff base for subsequent tasks. To reduce the air evacuation time in the firm cup, a novel self-sealing structure is designed. Based on the combined cup, we build a multifunctional aerial manipulation system which can execute perching or lateral aerial grasping tasks. With the proposed prototype, the comparative flight experiments involving perching on a wall under disturbance and grasping an object are conducted. The results demonstrate that our proposed suction cup outperforms the conventional cup.

The First Systematic Survey of Restaurant Hygiene in Paris, 1908

In 1908, an unpublished investigation by the French government discovered a number of commercial kitchens that violated the 1903 law regarding hygiene and security in the workplace. A linear-probability model shows that restaurants in tourist neighborhoods were 12 percentage points more likely to transgress sanitary regulations than those in non-tourist areas. Many of the kitchens in the expensive restaurants of central Paris were in basements where they lacked fresh air, sunlight, and efficient waste evacuation. Clientele also mattered as a determinant of insalubrity. Local repeat customers whose loyalty depended on constant restaurant standards tended to exert more pressure on sanitation than did tourists who based their choices on culinary reputation, such as recommendations in Baedeker’s travel guide.

Air evacuation and resin impregnation in semi-pregs: effects of feature dimensions

Prepregs with discontinuous resin (semi-pregs) impart robustness to vacuum-bag-only processing of composites. Limited guidance exists for evaluating advantageous resin patterns (i.e. dry space dimensions required to achieve both efficient air evacuation and full resin infiltration during cure). A flow front model was developed based on resin cure kinetics and rheological behavior, and then determined maximum dry space dimensions for semi-pregs under a range of realistic manufacturing conditions. Model predictions were validated in situ. Under controlled laboratory cure conditions, small surface openings (≤3.7 mm) resulted in full resin infiltration. Under adverse conditions (resin with accrued out-time), the maximum opening size dropped 40% (to ≤2.2 mm). Using a mathematical model, air evacuation time was calculated for various feature sizes using permeability measurements. Model predictions were tested and verified via fabrication of laminates. This methodology can be applied to other resin systems to guide vacuum-bag-only prepreg design and support robust production of composites.

Medical technical devices for medical evacuation of wounded and injured in emergency situations

Relevance. Medical evacuation of the wounded and injured in emergency situations of peacetime and wartime is an important component of medical support, which largely determines the effectiveness of medical care. The presence of a large number of victims forces us to use not only regular medical transport, but also any available vehicles for medical evacuation. Equipping vehicles with special modules and creating mobile medical technical devices that simultaneously solve the problem of monitoring physiological data, transport immobilization, transportation and treatment of the injured are certainly relevant. Intention. To analyze the use and justify the prospects for the development of medical technical devices for medical evacuation of victims in emergency situations of peacetime and wartime. Methodology. The subject of the study was the Russian and foreign experience in the medical evacuation of victims of emergency situation in peacetime and wartime. We conducted a retrospective analysis of the use of various systems and devices for the medical evacuation of the wounded and injured in emergency situations. The study of medical and technical characteristics, efficiency of use and development prospects of these devices was carried out using methods of historical analysis and comparison, logical analysis, expert estimates, system analysis and forecasting. Results and Discussion . It is shown that the technical improvement of medical evacuation can be carried out either by creating a special medical transport, or by developing devices that allow evacuating victims in any kind of transport while monitoring physiologically important functions and the possibility of carrying out basic resuscitation measures. Types of special medical transport created in the 70-80s of the 20th century for the evacuation of victims and the provision of qualified assistance on board (including in flight) were analyzed: the Mi-8MB “Bissectrisa” ambulance helicopter, resuscitation and operational aircraft An-26M “Spasatel”, operational-resuscitation aircraft laboratory IL-76MD “Scalpel”. The main medical and technical characteristics of mobile devices currently used for medical evacuation - medical modules for helicopter (MMB) and aircraft (MMS), medical air evacuation module STRATAIRMEDEVAC, multifunctional evacuation, transportation and immobilization unit METIU, medical evacuation device for seriously wounded UMETR, mobile rescue intensive care unit MIRF, and patient’s life support platform for transport LSTAT are presented. Promising developments - the diagnostic medical treatment and transportation complex for maintaining human vital activity “Angel” and a multifunctional robotic medical system are described. Conclusion. The use of special medical technical devices for medical evacuation makes it possible to increase the efficiency of medical care for the wounded and injured in emergency situations of peacetime and wartime.

Exploiting the versatility of vacuum-assisted headspace solid-phase microextraction in combination with the selectivity of ionic liquid-based GC stationary phases to discriminate Boswellia spp. resins through their volatile and semivolatile fractions.

The frankincense resins, secreted from Boswellia species, are an uncommon example of a natural raw material where every class of terpenoids is present in similar proportions. Diterpenoids (serratol, incensole, and incensole acetate) are used to discriminate samples from different species and origins. Headspace solid-phase microextraction has been used for frankincense analysis, although it requires long sampling time for medium- to low-volatility markers; headspace solid-phase microextraction under vacuum can overcome this limit. Gas chromatography is used for analysis but the separation of incensole and serratol needs polar stationary phases. In this study, we develop a method to discriminate frankincenses based on vacuum-assisted headspace solid-phase microextraction combined with fast gas chromatography-mass spectrometry with ionic liquid-based stationary phases. The optimized conditions for solid samples were: air evacuation below 0°C, 15min of incubation time, and 15min of extraction time. Losses of volatiles due to vial air-evacuation in the presence of the sample were minimized by sample amount above 100mg and low sample temperature. Fast gas chromatography provides the baseline separation of all markers in 20min. By applying vacuum sampling and fast gas chromatography, the total analysis was reduced to 50min compared to 120min (60min sampling plus 60min analysis) as previously reported. The method was successfully applied to commercial frankincense samples.

Aeromedical helicopter transport of prisoners: The Mexico City experience

Helicopter medical transport of prisoner patients has unique logistical and medical challenges, as well as potential risks to healthcare providers. Prisoners have specific requirements for safe transport, and it is of paramount importance to know the variables related to transport related mortality since most prisoners that need air evacuation are critically ill. Because we understand that there is a potentially dangerous nature of transport of this population, and because of the unique nature of them, we aimed to provide a detailed insight on predictors of outcome in prisoners who were injured as a result of trauma and that needed to be transported via air medical transport in Mexico City. A retrospective chart analysis was conducted using data from the Mexico City Police Helicopter Emergency Medical Service (HEMS) for air medical transport of felons that occurred between January 1, 2000 and December 31, 2013. Subject demographics, injury, procedures performed, transport time, Glasgow Coma Scale (GCS), and mortality were collected. Exploratory data analysis, Chi-square, and T-test were performed. Statistical significance was assumed to be p≤0.05 for two-sided hypothesis. Fifty-three patients were included in this study. Forty-two were men and 11 were women. Median age of the patients was 30±8years. Total transport time was 23±5min. Gunshot wounds accounted for 39.6% of patients, stabbing wounds 28.3%, head trauma 7.5%, motor vehicle accidents 5.7%, blunt trauma (i.e., fist assaults) 5.6%, falls 5.7%, motorcycle accidents 3.8%, and prisoner-motor vehicle collisions 3.8%. Median heart rate was 114±41 beats per minute (BPM), median systolic blood pressure (SBP) was 103±14mmHg, median diastolic blood pressure (DBP) was 70±12mmHg, and median GCS was 10±5. Mortality rate was 16.9% (n=9). The variables that were statistically significant, and therefore related to mortality were: heart rate>130bpm (p<0.001), SBP <95mmHg (p=0.039), GCS <7 (p=0.040), age>42years (range, 17-47years) p<0.001, and need for cardiopulmonary resuscitation (CPR) (p<0.001). As dangerous and challenging as it may seem, air medical transport of prisoners by a police crew physician, may be safe and reliable, since no complications or safety events were observed.

Diversity of non-tuberculous mycobacteria in heater-cooler devices: results from prospective surveillance

The international outbreak of cardiac surgery-associated Mycobacterium chimaera infections was traced back to infectious aerosols originating from contaminated water reservoirs of heater-cooler devices (HCD). In general, nontuberculous mycobacteria (NTM) frequently colonize water systems and can contaminate medical devices. Data on detection of NTM other than M. chimaera in samples gathered from HCDs are scarce. The present study summarizes prospective mycobacterial surveillance of five HCDs over more than four years. A cohort of five, in 2014 factory-new acquired, LivaNova 3T (London, UK) HCDs were prospectively followed. Until mid-April 2014 HCDs were maintained according to the manufacturer's recommendations, subsequently according to an intensified in-house protocol including exhaust air evacuation. Mycobacterial surveillance cultures consisted of monthly water samples gathered from patient and cardioplegia circuits, as well as airflow samples. Out of 441 water samples, 170 (38.6%) revealed NTM growth. The most frequently detected NTM were Mycobacterium chimaera (n=120 (67.4%)), Mycobacterium gordonae (n=35 (19.7 %)), and Mycobacterium paragordonae (n=17 (9.6%)). Growth of NTM, M. chimaera and M. paragordonae was significantly more common in water samples derived from the patient than the cardioplegia circuit of the HCD. Three (2.0%) out of 150 air samples grew NTM. Growth of NTM in HCD water samples was frequent. Diverse NTM species were detected, with M. chimaera being most common. The majority of air samples remained negative. The relevance of NTM other than M. chimaera contaminating HCDs is poorly defined, but a recent report on a HCD-associated outbreak with Mycobacterium abscessus confirms a potential threat.

Air medical evacuation in patients with post craniectomy

Medical air evacuation has some effect including hypoxia, deep vein thrombosis (DVT), dehydration and gas development in the body cavity. Descriptive qualitative research method with a case study approach has been carried out and participatory observation of the process of medical air evacuation in patients with Hematoma Post Craniectomy Et Causa Frontoparietalis Sub Dural by using flight documentation forms before flight and post flight. The results showed that the nursing care provided by flight nurses to patients was to anticipate conditions during the flight including pre-flight, in-flight and post-flight. The conclusion of this study is that air medic evacuation conducted by an air nurse can run well starting from the evacuation preparation which consists of patient preparation, administration preparation, aircraft preparation and medical equipment so that during the flight the patient's condition is stable until arriving at the destination.

A Hidden Complication of Pigtail Catheter Insertion.

Pigtail catheters have emerged as an effective and less morbid alternative to traditional chest tubes for evacuation of pleural air. Rare complications in the literature have been reported. We report a case of a 92-year-old male who presented with dyspnea and shock, noted to have a pneumothorax requiring tube thoracostomy. Computed tomography demonstrated pigtail within the lung parenchyma. We discuss the implications of this occurrence.

Mechanisms of inter‐ply void formation during vacuum bag‐only cure of woven prepregs

AbstractThe removal of inter‐ply air is critical for limiting porosity in laminates. In this study, an in situ monitoring technique was employed to observe inter‐ply air evolution during vacuum bag‐only cure. Observations showed that reduced vacuum resulted in inefficient inter‐ply air evacuation, a more rapid bubble expansion rate, and formation of new air bubbles. A modified tow impregnation model showed that resin infiltration was impeded at reduced vacuum conditions due to the presence of intra‐tow air. However, the cured laminates showed that tows were fully impregnated in all cases, indicating that the entrapped intra‐tow air migrated to inter‐ply regions during cure. The interactions between intra‐tow and inter‐tow air at deficient vacuum conditions were revealed. Findings led to the conclusion that air remaining in intra‐tow regions contributed more to the increase of inter‐ply voids than the reduction in consolidation pressure difference associated with reduced vacuum.

Effects of debulk temperature on air evacuation during vacuum bag-only prepreg processing

Air removal prior to cure is critical for limiting porosity during vacuum bag-only (VBO) processing of prepregs. In this study, the effects of pre-cure dwell temperature (debulk) on air evacuation were investigated for both plain weave (PW) and unidirectional (UD) prepregs. In situ observations revealed that increasing dwell temperature promoted inter-ply air evacuation (by as much as 2x for UD prepregs). Through-thickness gas permeability increased with increasing temperature and decreased with increasing number of plies. The decrease in in-plane permeability during heated debulk was attributed to increased tow impregnation. The findings provide guidelines for cure cycle optimization. Heated debulk enhanced air evacuation in PW laminates, particularly as laminate width/thickness ratios exceed a threshold value. However, warm debulks were less effective, particularly for thicker laminates (>8 plies).

The influence of different rewetting procedures on the thrombogenicity of nanoporous poly(ether imide) microparticles.

Nanoporous microparticles prepared from poly(ether imide) (PEI) are discussed as candidate adsorber materials for the removal of uremic toxins during apheresis. Polymers exhibiting such porosity can induce the formation of micro-gas/air pockets when exposed to fluids. Such air presenting material surfaces are reported to induce platelet activation and thrombus formation. Physical or chemical treatments prior to implantation are discussed to reduce the formation of such gas nuclei. Here, we report about the influence of different rewetting procedures - as chemical treatments with solvents - on the thrombogenicity of hydrophobic PEI microparticles and PEI microparticles hydrophilized by covalent attachment of poly(vinyl pyrrolidone) (PVP) of two different chain lengths.Autoclaved dry PEI particles of all types with a diameter range of 200 - 250 μm and a porosity of about 84% ±2% were either rewetted directly with phosphate buffered saline (24 h) or after immersion in an ethanol-series. Thrombogenicity of the particles was studied in vitro upon contact with human sodium citrated whole blood for 60 min at 5 rpm vertical rotation. Numbers of non-adherent platelets were quantified, and adhesion of blood cells was qualitatively analyzed by bright field microscopy. Platelet activation (percentage of CD62P positive platelets and amounts of soluble P-Selectin) and platelet function (PFA100 closure times) were analysed.Retention of blood platelets on the particles was similar for all particle types and both rewetting procedures. Non-adherent platelets were less activated after contact with ethanol-treated particles of all types compared to those rewetted with phosphate buffered saline as assessed by a reduced number of CD62P-positive platelets and reduced amounts of secreted P-Selectin (P < 0.05 each). Interestingly, the hydrophilic surfaces significantly increased the number of activated platelets compared to hydrophobic PEI regardless of the rewetting agent. This suggests that, apart from wettability, other material properties might be more important to regulate platelet activation. PFA100 closure times were reduced and within the reference ranges in the ethanol group, however, significantly increased in the saline group. No substantial difference was detected between the tested surface modifications. In summary, rewetting with ethanol resulted in a reduced thrombogenicity of all studied microparticles regardless of their wettability, most likely resulting from the evacuation of air from the nanoporous particles.

Effect of the presence of a shoulder on the thermal and dynamic structure of a laminar flow in an air-plane solar collector

A numerical study of the forced convection of a two-dimensional laminar air flow through a rectangular pipe with a shoulder is presented. The profiles and contours of velocity and temperature were analyzed in detail. The effects of the location of this shoulder on the insulation and on the absorber, and its height on the variations of the temperature and the velocity at the exit of the collector were also studied and compared with the case without shoulder, for a flow rate varying between 20 and 80 m3/h. The results show that the use of a shoulder placed on the insulator or on the absorber contributes to increasing the dynamic and thermal performance of the flow compared to the simple case; an average temperature gain of 25.52 °C at 56.6 °C is obtained for the low and high flow rates, respectively. The study also revealed that the use of the largest height h3 rated absorber can significantly increase the velocity (of the order of 222%) compared to the simple case. In addition, this location allows to direct the flow at the entrance of the drying chamber downwards, which leads to better evacuation of moist air at the chimney outlet.

Aeromedical Evacuations Within the French Armed Forces: Analysis of 2,129 Patients.

The doctrine of medical support during French military operations is based on a triptych: forward medical stabilization, forward damage control surgery, and early strategic aeromedical evacuation (Strategic-AE). The aim of this study was to describe the last piece, the evacuation process of the French Strategic-AE. We conducted a retrospective cohort analysis using patient records from 2015 to 2017. All French service members requiring an air evacuation from a foreign country to a homeland medical facility were included. Data collected included age, medical diagnosis, priority categorization, boarding location, distance from Paris, type of plane and flight, medical team composition, timeline, and dispatch at arrival. We analyzed 2,129 patients evacuated from 71 countries, most from Africa (1,256), the Middle East (382), and South America (175). Most patients (1,958) were not severely injured, although some considered priority (103) or urgent (68). Diagnoses included disease (48.6%), nonbattle injuries (43%), battle stress (5.3%), and battle injuries (3%). 246 Strategic-AE used medical teams in flight, 136 of them in a dedicated Falcon aircraft. The main etiologies for those evacuations were battle injuries (24%), cardiovascular (15.4%), infections (8%), and neurologic (7.3%). The median time of management for urgent patients was about 16hours but longer for priority patients (26hours). Once in France, 1,146 patients were admitted to a surgery department and 96 to an intensive care unit. This is the first study to analyze the French Strategic-AE system, which is doctrinally unique when compared to its North Atlantic Treaty Organization allies. North Atlantic Treaty Organization allies favor care in the theatre in place of the French early Strategic-AE. However, in the event of a high intensity conflict, a combination of these two doctrines could be useful.

Patient transportation in Canada's northern territories: patterns, costs and providers' perspectives.

Canada's northern territories are characterized by small, scattered populations separated by long distances. A major challenge to healthcare delivery is the reliance on costly patient transportation, especially emergency air evacuations (medevacs). The purpose of this study was to describe the patterns, costs and providers' perspectives on patient transportation, and identify potential factors associated with utilization and performance. Secondary analyses of medical travel databases and an online survey of nurses in the communities and physicians in regional centers were undertaken. The proportion of the population living within 100 km of a hospital was 83% in Yukon, 63% in Northwest Territories (NWT) and 21% in Nunavut. In Nunavut and NWT, road access to a hospital was limited to residents of the cities where the hospitals were located, with the rest relying exclusively on air travel. Medevac rates varied among the three territories: 0.9 trips/1000 residents/year in Yukon, 32/1000 in NWT and 53/1000 in Nunavut. In Yukon, all communities except one are road-accessible whereas in Nunavut no communities are connected by roads. The relative absence of roads is a major reason why the patient transportation costs are high in Nunavut and NWT. The rate of medevacs originating from the remote, air-accessible-only communities varied greatly, which cannot be explained by the air distance from the nearest hospital, population size or frequency of health center visits. Medical travel accounts for 5% of the health expenditures in NWT and 20% in Nunavut. A medevac on average costs $218 per person per year in NWT and $700 in Nunavut. The providers survey detected only 66% or less in support of statements that nurses in the communities received timely access to clinical advice, whereas only 50% of physicians agreed with statements that the clinical information provided by the nurses was clear. Patient transportation, especially emergency air evacuations, is an essential but costly component of the healthcare system serving Canada's north. It is the 'glue' that binds an extensive network of facilities staffed by different categories of health professionals. While system design is largely dictated by geography, addressing human factors such as interprofessional communication is important for improving the system's effectiveness. This study is primarily descriptive and it points to additional areas for improved understanding of the performance of the system.

Augmenting the Capacity of Air Evacuation System of Condensers in 210 MW LMW Turbines by Replacing Main Ejectors and Starting Ejectors by Liquid Ring Vacuum Pump and CFD Analysis of Sealing in the Liquid Ring Vacuum Pump

Augmenting the Capacity of Air Evacuation System of Condensers in 210 MW LMW Turbines by Replacing Main Ejectors and Starting Ejectors by Liquid Ring Vacuum Pump and CFD Analysis of Sealing in the Liquid Ring Vacuum Pump

New insights and improved strategies for the management of primary spontaneous pneumothorax.

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.

Safety and Flight Considerations for Mechanical Circulatory Support Devices During Air Medical Transport and Evacuation: A Systematic Narrative Review of the Literature

ObjectiveThe air medical transportation industry has seen a steady rise in the use of mechanical circulatory support devices (eg, intra-aortic balloon pumps, ventricular assist devices, and extracorporeal membrane oxygenation) during transport missions, either for definitive management or repatriation. As these complex devices become more common, the industry will have to adapt to support their use in their clientele. The goal of this narrative review was to assess our current experiences regarding mechanical circulatory support devices in air medical transportation and to identify important factors to ensure successful transport. MethodsWe conducted a systematic search on MEDLINE and Embase using the following search terms: aeromedical transportation, air transportation, intra-aortic balloon pump, ventricular assist device, and extracorporeal membrane oxygenation. Results were cross-referenced to identify articles addressing both air medical transport and mechanical circulatory support devices. ResultsAfter a systematic review of the available literature, 49 articles addressing mechanical support devices transported by rotary wing and fixed wing aircraft were reviewed. In summary, our review encompassed 811 total aerial transports (152 by balloon pumps, 12 by ventricular assist devices, and 647 by extracorporeal membrane oxygenation). We found air medical transportation with these devices carried out in the public, private, or military sectors, to be safe, with low rates of serious adverse events. Dedicated training sessions focused on device troubleshooting and problem-solving during transport, optimal medical crew composition, predeparture logistical preparations, and on-demand specialist consultation can improve mission success. ConclusionWe report that air medical transportation of patients supported by mechanical circulatory support devices is safe. Complications can be mitigated by training and addressed either during the predeparture or in-transportation phase.

Craniotomy and Evacuation at Remote Island Hospital; Challenges and Way Ahead

We herein report the management of a case of acute-on-chronic subdural hematoma by emergency craniotomy at mid-zonal hospital with basic surgical facilities. The timely intervention has made significant difference in patient outcome. A 72-year-old male was on antiplatelet agents, presented with status epilepticus, and also had multiple comorbidities. We faced challenges of specialist consultation, medical evacuation of an intubated case, neurosurgery intensive care, and availability of blood products and intensivists at place like Andaman and Nicobar islands where connectivity remains a challenge. Casualty evacuation and transport of critical patients by air are a major exercise and are not possible in certain situations. Moreover, it is potentially detrimental to the life of a patient during air evacuation due to changes in the atmospheric pressure. In such adverse situations, aggressive surgical intervention at small centers can make significant difference in the outcome of patient.

The Prehospital Trauma Registry Experience With Intraosseous Access.

Peripheral intravenous (IV) cannulation is often difficult to obtain in a patient with hemorrhagic shock, delaying the appropriate resuscitation of critically ill patients. Intraosseous (IO) access is an alternative method. To date, few data exist on use of this procedure by ground forces in Afghanistan. Here, we compare patient characteristics and concomitant interventions among patients undergoing IO access versus those undergoing IV access only. We obtained data from the Prehospital Trauma Registry (PHTR). When possible, patients were linked to the Department of Defense Trauma Registry for outcome data. To develop the cohorts, we searched for all patients with documented IO or IV access placement. Those with both IO and IV access documented were placed in the IO group. Of the 705 available patients in the PHTR, we identified 55 patients (7.8% of the population) in the IO group and 432 (61.3%) in the IV group. Among patients with documentation of access location, the most common location was the tibia (64.3%; n = 18). Compared with patients with IV access, those who underwent IO access had higher urgent evacuation rates (90.9% versus 72.4%; p = .01) and air evacuation rates (58.2% versus 14.8%; p < .01). The IO cohort had significantly higher rates of interventions for hypothermia, chest seals, chest tubes, needle decompressions, and tourniquets, but a significantly lower rate of analgesic administration (ρ ≤ .05). Within the registry, IO placement was relatively low (<10%) and used in casualties who received several other life-saving interventions at a higher rate than casualties who had IV access. Incidentally, lower proportions of analgesia administration were detected in the IO group compared with the IV group, despite higher intervention rates.