IO versus IV access while wearing personal protective equipment in a HazMat scenario

Objective. Determine the time difference obtaining intraosseous (IO) versus intravenous (IV) access while wearing personal protective equipment (PPE) in simulated HazMat scenarios. Methods. Twenty-two EMT-P providers established anterior tibial IO access using the EZ-IO® system and routine antecubital IV access in three mannequin and PPE HazMat scenarios: 1) provider and mannequin not in PPE, 2) only provider in Level C PPE, and 3) provider and mannequin both wearing Level C PPE. Primary outcome measures were the average time in seconds for skin access, vascular access, and fluid infusion with each method in these configurations. Results, For the provider and mannequin not in PPE condition, needle to skin time favored the IV (6.2 vs. 9.3 seconds; p < 0.001). whereas vascular access time (12.8 vs. 36.3 seconds; p < 0.001) and fluid infusion time (26.2 vs. 36.5 seconds; p = 0.02) favored the IO approach. For the provider in PPE and mannequin not in PPE condition, needle to skin times were similar for IO and IV (10.4 vs. 12.7 seconds; p = 0.591), whereas vascular access time (14.0 vs. 46.0 seconds; p < 0.001) and fluid infusion time (28.3 vs. 45.7 seconds; p < 0.001) both favored the IO approach. With the provider and mannequin in PPE, needle to skin time (12.7 vs. 24.9 seconds; p < 0.001), vascular access time (16.9 vs. 62.7 seconds; p < 0.001), and fluid infusion time (29.5 vs. 66.1 seconds; p < 0.001) all favored the IO approach. Fluid infusion times for the provider not in and in PPE (26.2 vs. 28.3 seconds; p < 0.05) with the mannequin not in PPE revealed no significant time burden associated with using the EZ-IO® device with the provider in PPE. Conclusions. Overall, the EZ-IO® system under HazMat conditions provides vascular access and fluid more quickly than standard intravenous access. When providers and mannequins were both in PPE, the time differential between IO and IV access was the greatest, favoring the IO approach. Donning PPE did not hinder the providers' use of the EZ-IO® device and may be useful for obtaining vascular access when wearing PPE.