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Does Your Ambulance Have One Yet?

25 comments

THE GRAND ISLAND (NEBRASKA) FIRE DEPARTMENT HAS JUST added another tool to each of their four front-line ambulances, a bone drill.

bone drill a independent Barrett

Division Chief Troy Shubert demonstrates the use of a bone drill on a
training bone, which features a foam rubber “skin” section
over the bone, at Grand Island Fire Station No. 1.
(Grand Island Independent / Barrett photo)

The small, hand-held drills cost them $6,300 for all four and already they don’t know how they ever got along without them.  The tools are used as a back-up means of establishing an IV line in patients that are too difficult to reach a vein in the traditional manner.

The Grand Island Independent continues:

A bone drill is used when a traditional IV cannot be secured on a patient. It could be because the patient is dehydrated, diabetic or under extreme trauma, Shubert said.

The bone drill can be used to quickly insert an intraosseous needle directly into the bone to dispense fluids, medications or sugar.

“The procedure has been around forever,” Shubert said. “This is just a different tool to drive it in.”

Previously, paramedics used a small, handheld plug to literally ram the needle into the patient’s leg bone near the knee.

“If you’re just doing it by hand, it’s tougher,” said Dr. Michael McGahan, the department’s medical supervisor and an emergency room doctor and supervisor at St. Francis Medical Center.

The paramedics began by practicing on chicken bones and synthetic training limbs to learn the “feel” for hitting the bone properly.  Once the drills were in service, they had use for one within a week.  The hospital staff were so impressed with the results of the use of the drill that they ordered one for their ER.

Read the entire story in The Independent HERE.

Posted by on October 18, 2009 • Filed under: ambulances, EMS Topics • Tagged: , , ,
  • Ralph

    The local ER used one Firday morning on a pt we couldn`t get a line started on. I`m not pointing fingers at the device, which in my opinion is fantastic. The batteries died half way into the procedure. We don`t carry them yet, but I wonder if there is a way to do a daily battery check? Now, maybe the battery died because it had to go thru so much tissue on this particular pt? Very obese, I mean almost 2 inches of tissue and swelling to get to the upper tibia. I can`t wait till we carry them on our trucks.

  • http://thehappymedic.com the Happy Medic

    Our Paramedic supervisors carry them and can be called or added to a dispatch should the dispatcher think we may need it. They hope to add them to each kit, but cost and space are a big issue.

    Seems a much better tool than the sternal IO dart disc device that was making the rounds a few years ago.

  • Ckemtp

    I love my Ez-IO. I don't know how I ever got along without it. One medic, or EMT-Intermediate, can place a stable, large bore IO in under twenty seconds and can push darn near any emergency medication we carry through it.

    It's a big part our sucesses with resuscitating cardiac arrests and I wouldn't trade it for anything.

    You said “The battery died”!? Really? Never heard of that and that's odd. I wrote an article on this a while back ago and it attracted the attention of Vida Life's marketing director so I know they search for mention of their products. Maybe he'll come and answer that question.

  • Ralph

    Ckemp,
    I`d love to have them in our cars. The company is pretty progressive with equipment, it`s just one of those “toys” we don`t have yet. The Ex-IO in question, was in the crash cart in the local ER. This particular ER is not by any means a trauma center, nor is it really very busy with anything critical. The device may have been in that cart since it was initially placed into service, one can only guess how long ago that was.

  • http://mack505.blogspot.com/ mack505

    Yup, have 'em and love 'em.

    First line in the cardiac arrest – we don't even fool around with peripheral IVs then. It has the added bonus that the tibial placement keeps it clear of all the action around the chest and the airway.

  • Ckemtp

    I'll see if I can't track down that guy from the company to see if they've had any other like incidents. I love my IO drill and wouldn't trade it for anything. I've never used the sternal IO, and I've only played with the BIG (Bone Injection Gun) but I have to say that with the information I have available, the EZ-IO is the best.

    We'll see if I can get them to comment.

  • mickmayers

    Used ours the other night to resuscitate a drowning victim. He's still with us. Keep your fingers crossed.

  • http://www.facebook.com/Firefighterbard Erik Prager

    City of Virginia Beach, VA EMS has been utilizing Ez-IO for about 6-7 months now and has recently placed an EZ-IO kit on every ambulance and paramedic zone car in the City. While not a Paramedic, I have seen it's effectiveness in the field.

  • ofr421

    Used one friday evening in a cardiac arrest save. The patient is up and talking to his family today.

  • http://www.999medic.com Medic999

    We too have just recieved our first bone drills for the ez-io system. I get my training for it on Thursday this week and am looking forward to having that extra option for access when needed.
    But that's the important thing though….'when needed'
    Whenever a new invasive technique gets approved, there is usually a minority of people who want to use it 'no matter what'.

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  • http://www.vidacare.com/ez-io/index.html Steve Dralle

    Thanks for such a great article! This is Steve Dralle, director of marketing for Vidacare. The battery failure question is a great one. On our homepage (linked on this post) and on our facebook page (here: http://www.facebook.com/album.php?aid=127150&id…) we have a video that illustrates what could be happening. The question is, does the driver work now? If you power the device does it still sound like it works fine but slowed down and stopped during the insertion? If it does then the issue is most likely that too much pressure was applied during insertion (the video illustrates this). If you apply too much pressure you slow the driver down which slows the insertion which increases friction which can, on occasion, stop the driver. When you hear your driver slowing the solution is to reduce pressure, not increase it. If you are not sure if your driver is working correctly, please call 1-800-680-4911 choose option 2 and we will call you back and trouble shoot the driver with you. The most likely solution is too much pressure during insertion but call and we can make sure.

    Thanks again for the great discussion!
    Steve Dralle

  • http://www.facebook.com/bigron Ron Webb

    I teach others in how to use the EZ-IO and when comparing the EZ-IO needle to the traditional bone aspiration needles, I point out that using hand power only is similar to a non-skilled person driving a nail with a light-weight hammer… the nail may be struck from different directions and wobbles a lot as it goes in; making a larger hole. A nail gun or an experienced framer puts the nail in with one shot or one big swing of the hammer after nail placed. The hole in the wood is only size of the shaft of the nail. Also, the bone aspiration needle sticks out 3-4 inches with less than 1 inch inside… EZ-IO sticks out less than an inch, so stabilization is much better with the EZ-IO. Many people have a “yuck factor,” especially the hospital-based nurses often in my classes, so we show a video of healthy volunteers being drilled, showing their pain responses… much different than the students anticipated. The use of IO should be left to more emergent situations, but the point is that it is not as bad as the mental image.

  • http://www.cvcinc.com/ James Giaudrone

    As a Rep for the EZIO system in Oklahoma, it does my heart good to hear the comments from medix across the nation. Now for some of the questions I have read, First if a Driver “DIED” during usage the most common thing has been EXCESS pressure being applied during the insertion. It is possible that it was a very old driver with maybe alkaline batteries(first generation) if so then there are several options to upgrade the driver for no charge.

    For the other devices mentioned by users, the EZIO system has a documented 98% success rate while the closest is in the 60% range. The EZIO system is the ONLY intraosseus system that CUTS a hole into the bone like an orthopedic drill bit, others use blunt force to puncture a hole in the bone like a nail hit by a hammer. If you ever have questions about the EZIO please call the 24 hour support line 800-680-4911 or call your local rep. We are available 24 hours and as always training is provided at no charge and is in fact encouraged for best results. Good luck to all medics out there and THANK YOU for doing your job. God Bless.

    James Giaudrone
    giaudrone@cvcinc.com

  • Ralph

    I thank everyone for their replies. I would chalk up the “failure” I saw and commented on to one of two catagories. First off, the patient`s leg condition. The amount of tissue and edema. Second, the physician that attempted placement was by no means experianced with the device. Again, the device has been in the trauma cart for an unknown time. Having worked around this ER for the last 3 years, I have never witnessed an IO even attempted.

    I would still like to carry them in our ambulances. They are a wonderful tool. I did not intend to initiate a storm by my “failure” comment. I applogize if I caused any grief to the manufacturer.

  • http://www.medicthree.com/ medicthree

    We don't have the drills here, but I'm not afraid to use a hand IO in a pinch. IO access is THE next thing in access. I'd choose IO administration over ET any day

  • Name

    Bill, we have been using IO's in Fairfax City for almost 2 years.

  • TheFireCritic

    Our Department uses them. All of our Medic trucks carry them. I have seen the batteries die on a call too.

    I have heard that there are some pretty bad cases of infections from using them from some medics in our department too.

    It seems like a decent tool. Seems like it would hurt like hell though.

  • http://www.cvcinc.com/ James Giaudrone

    Excuse Me!?!?!? First of all, the batteries should not fail they are rated for 1000 insertions.

    Second, the “PRETTY BAD CASES OF INFECTIONS” that you claim have not been reported to the FDA or CDC or to the manufacturer, which claims by the way that there have been over 500,000 insertions without a SINGLE infection being reported.

    Intraosseus access overall from the start of recorded medical data has only a 0.6% infection rate, that is also documented compare that to 1.5 – 3 % for peripheral IV and up to 12% for Central lines and Femoral lines.

    Lastly, the “HURTS LIKE HELL” comment. It is true that pain is relative, however the insertion is comparable to a standard IV stick. Pain of fluid infusion is much greater but can be controlled with the proper dosing of Cardiac Lidocaine.
    I can personally attest to this I have had an EZIO needle catheter placed in my left proximal tibia and so I speak from personal experience.

  • Ralph

    James,

    I was wondering the same thing when I read that post.

  • TheFireCritic

    James,

    Have a seat and calm down a minute.

    I am not harboring ill will about the EZ-IO. I was just offering some of the things that I have witnessed and heard.

    As for my comment on the batteries dying. Maybe it wasn't the batteries. Maybe the whole unit bit the dust. My point is that I have seen it stop working for whatever reason. It wasn't an old unit either. I have seen it with my own eyes, but according to you it cannot happen.

    As for the comment on the infections. Thanks for explaining. I guess the Medic's I have heard this from didn't know what they were talking about, were citing bad data, or had other data that you didn't. I didn't ask for proof at the time of the statement.

    As for the comment on the pain…I will take your word for it.

  • http://www.vidacare.com/ Steven Dalle

    All,
    Steve Dralle from Vidacare again. I just wanted touch a couple areas. First, anytime you have a concern or problem with any of our products please call our 800-680-4911 customer support line. We really want to work with you to make sure that we look into any concerns you have and make sure we identify root causes. The complication rate of intraosseous access across the history of IO is approximately 0.6%. We manufactured more than 500,000 needles and are confident that about 350,000 have been used in patients. Additionally, more than 3,000 patients have received EZ-IOs in studies or trials which are published in the medical literature. In all of this, the reported complication rate for our product is still below the historic IO complication rate.
    If a medic tells you that they have a concern with the EZ-IO, encourage them to contact us so we can work with them to understand the root cause. Our priority is to work with clinicians to look for ways to improve our product's performance.
    Finally, regarding pain, insertion pain is roughly equivalent in intensity to an 18 gauge IV stick. That is about the level it felt to me as well. So it does hurt, but not any more than a medium sized IV, so if a patient will tolerate an IV, they will tolerate an IO, however if they cannot tolerate an IV insertion, the IO will hurt them as well. However, the infusion pain is something that needs to be managed in patients responsive to pain, if allowed under your protocol.
    Thanks,
    Steve

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  • TheFireCritic

    We used the EZIO on a call today. It was a code and it worked seamlessly. Pushed several drugs (the medics…as I am not).

  • http://firecritic.com Fire Critic

    We used the EZIO on a call today. It was a code and it worked seamlessly. Pushed several drugs (the medics…as I am not).