IV/IO Protocol

05/17/21 • 47 min

In this episode, Trevor and Morgan talk to Dr. Whit Harvey, USN, about one of the foundational skills of out-of-hospital care: IV and IO access. Dr. Harvey has done important research on IO efficacy, and he shares some of his findings about the pressure required to keep IOs flowing, as well as techniques to generate that pressure (it's more than you think!).
Additionally, Trevor mentions some critical points about flow rates through IV tubing and lock devices. This can be a blind spot for a lot of us; the convenience of a lock is great, but those couple inches of tubing can significantly reduce flow rates, and that is not ideal if you're infusing blood. There is some pain associated with flushing an IO, and this article has some good information about just how much Lidocaine you should be using to reduce your patient's discomfort.

Previous Episode

Progressive Medical Direction

Drs. Will Smith, Steve Rush, and Ben Walrath join us for a great conversation about the role of the military EMS director. These three men have accumulated significant experience leading MEDEVAC/CASEVAC organizations, and their perspective is valuable for flight medics and Flight Surgeons alike.
During the episode, the conversation frequently emphasizes the importance of educational resources for flight docs, especially:

deployedmedicine.com
The Joint Trauma System's Pre-deployment Prioritized Read Lists by Clinical Role
COL Robert Mabry's seminal papers:
- Mabry, R. L., & De Lorenzo, R. A. (2011). Improving role I battlefield casualty care from point of injury to surgery. US Army Medical Department Journal, 87-92.
- Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.
Medical direction courses at SOMSA

Furthermore, Dr. Smith highlights the National Association of EMS Physicians Military and Federal Agency Chapter, a relatively new effort in which Dr. Walrath has a leadership role.
Thanks for listening, and be sure to share your thoughts with us via dustoffmedicpodcast.com, on Facebook, or @dustoff.medic.podcast!

Next Episode

Conflicts Across Role 1 Guidelines

Dr. Andy Fisher and Dr. Steve Schauer join us along with Sarah Johnson and Ryann Lauby to discuss their paper, "An Analysis of Conflicts Across Role 1 Guidelines." The paper, published last year in Military Medicine, compared a number of DOD pre-hospital care guidelines, including the SMOG. The authors concluded that "the reduction or elimination of conflicting information across the various guidelines, augmentation of guidance for pediatric care, more specific guidance for unique levels of care, and clear delineation of the Role 1 phases of care (as well as which guidelines are more appropriate to each) should be considered as urgent priorities within the military medical community."
Our podcast has always tried to incorporate the perspective of rotary-wing flight medics from the different branches of service. When we discuss clinical topics, we survey guidelines and protocols across the DOD in an effort to identify conflicts and, hopefully, discern best practices. This paper is directly related to that work, and this conversation is a great way to understand the authors' intent as well as ways forward. Please give it a listen and let us know your thoughts!
Johnson, S. A., Lauby, R. S., Fisher, A. D., Naylor, J. F., April, M. D., Long, B., & Schauer, S. G. (2020). An Analysis of Conflicts Across Role 1 Guidelines. Military Medicine.