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The First Access for Shock and Trauma (FAST 1) Sternal Intraosseous (IO) System is a vascular access device designed as an alternative to peripheral or central intravenous (IV) cannulation for the treatment of critically ill and injured adults. During the development of the device, key objectives included safety, speed of insertion, and ease of use with minimal training. This study evaluated these characteristics.
Ten experienced paramedics participated in a 90-minute training program for the use of the FAST 1 System at the Paramedic Academy of the Justice Institute of British Columbia. Then, the paramedics used thesystem in three simulated prehospital scenarios and evaluated the ease of use and compatibility of the training method with current practice using a 10-centimeter (cm) (3.94 inches (in)), visual analog scale.
The duration of the procedure from opening the package to initiation of fluid flow ranged 52–127 seconds (mean = 92 ±32 seconds). Placement accuracy was excellent, with a mean displacement of 2 mm (0.08 in) and 1 mm (0.04 in) in the vertical and horizontal planes, respectively. The paramedics rated the system highly in all areas. They considered the training “straight forward” and “comprehensive”. The possibility for interference between the IO system and cervical collars was reported, and several suggestions to remedy this and achieve other improvements were made.
Placement of the FAST 1 is fast, accurate, and easy to use. Paramedics had useful input concerning the design of the product.
Pulse-oximetry has proven clinical value in Emergency Departments and Intensive Care Units. In the prehospital environment, oxygen is given routinely in many situations. It was hypothesized that the use of pulse oximeters in the prehospital setting would provide a measurable cost-benefit by reducing the amount of oxygen used.
This was a prospective study conducted at 12 ambulance stations (average transport times >20 minutes). Standard care protocols and paramedic assessments were used to determine which patients received oxygen and the initial flow rate used. Pulse-oximetry measurements (oxygen-saturation measured by pulse oximetry) were then taken. If oxygen-saturation measured by pulse oximetry fell below 92% or rose above 96% (except in patients with chest pain), oxygen (O2) flow rates were adjusted. Costs of oxygen use were calculated: volume that would have been used based on initial flow rate; and volume actually used based on actual flow rates and transport time.
A total of 1,907 patients were recruited. Oximetry and complete data were obtained on 1,787 (94%). Of these, 1,329 (74%) received O2 by standard protocol: 389 (27.5%) had the O2 flow decreased; 52 had it discontinued. Eighty-seven patients (6%) not requiring O2 standard protocol were hypoxemic (oxygen-saturation measured by pulse oximetry < 92%) by oximetry, and 71 patients (5%) receiving oxygen required flow rate increases. Overall, O2 consumption was reduced by 26% resulting in a cost-savings of $0.20 / patient. Prehospital pulse-oximetry allows unncessary or excessive oxygen therapy to be avoided in up to 55% of patients transported by ambulance and can help to identify suboptimally oxygenated patients (11%).
Rationalizing the O2 administration using pulse-oximetry reduced O2 consumption. Other health care savings likely would result from a reduced incidence of suboptimal oxygenation. Oxygen cost-saving justifies oximeter purchase for each ambulance annually where patient volume exceeds 1,750, less frequently for lower call volumes, or in those services where the mean transport time is less than the 23 minute average noted in this study.
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