The Emergency Medicine Journal recently published a review of intraosseous access experience from the Royal Army Medical Corps. This review documents 1,014 IO devices and 5,124 infusions of blood products, medications, and fluids. There were no major complications, and the rate of minor complications was extraordinarily low – the most frequent being device failure, occurring approximately 1% of the time.

But, what is the role of intraosseous access in trauma?

IO access in trauma. Minimal utility IMHO. In adults not sure there is any place at all. #austrauma — Karim Brohi (@karimbrohi) October 4, 2014

Who is Dr. Brohi, you may ask? Just the head of the LondonTIER, Professor of Trauma Sciences in the Blizard Institute, Barts and the London School of Medicine & Dentistry, and Consultant Trauma & Vascular Surgeon at Barts Health NHS Trust. Someone whose opinion is worth a listen. If you have any doubts, watch him speak at SMACC GOLD.

To say his comment spurred a rivulet of FOAM would be an understatement. To see the entire thread of responses and branching conversations, start here and don’t stop scrolling. But, a few of the highlights:

@karimbrohi Wow! Controversial! I'd agree, but with the caveat that it's "of limited utility within an expert system" — John Hinds (@DocJohnHinds) October 4, 2014

@PBSherren I don't think we should be using things that don't work well and where there are viable alternatives — Karim Brohi (@karimbrohi) October 5, 2014

@EMSwami @Rx_Ed @FLTDOC1 @mjslabbert vascular access is for blood, fluids or drugs… IO v poor for blood. Fluids limited in trauma… — Karim Brohi (@karimbrohi) October 5, 2014

@EMSwami @Rx_Ed @FLTDOC1 @mjslabbert alt routes for drugs or slight extra time for CVC gives much better future use. In general. — Karim Brohi (@karimbrohi) October 5, 2014

@EMSwami @Rx_Ed @FLTDOC1 @mjslabbert in most cases I'd say time saved not clinically important (quicker but only by a couple of mins) — Karim Brohi (@karimbrohi) October 5, 2014

What do you think? Do you agree – the IO is, as used by the Royal Army Medical Corps (RAMC), a temporary tool prior to definitive access in a trauma center? Or, do you find utility, even in the setting of a fully capable trauma resuscitation?

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