1. Early Use Of Intraosseous Cannulation In Emergencies: Drilling Home The Message Sally Evans Critical Care Nurse Educator Bendigo Health

2. No conflict of interest

3. Photos from Bendigo Health archives

4. Intraosseous cannulation “Rather, ten times, die in the surf, heralding the way to a new world, than stand idly on the shore” Florence Nightingale (1820-1910) Photo from Flickr

5. Photo from Bendigo Health archives

6. Photo by Sally Evans

7. Photo from Bendigo Health archives

8. Photo by Sally Evans

9. Photo from Flickr

11. Photo by Sally Evans

12. Photo from Flickr

14. Does IO = IV?

15. American J Emerg Med 2008 26 (1) ‘Does intraosseous equal intravenous? A pharmacokinetic study’ D Von Hoff, J Kuhn, H Burris & L Miller

16. Arch Pathol Lab Med. 2010; 134 ‘A New Study of Intraosseous Blood for Laboratory Analysis’ L Miller, T Philbeck, D Montez, C Spadaccini

17. Emergency Medical Journal 2014 ‘Saving the critically injured trauma patient: a retrospective analysis of 1000 uses of intraosseous access’ Philippa Lewis & Chris Wright

18. Emergency Medical Journal 2014 ‘Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study’ Authors: E B G Barnard, R J Moy, A D Kehoe, V S Bebarta, J E Smith

19. J Vasc Access 2013 14(3) ‘Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting’ Authors: M Dolister, S Miller, S Borron, E Truemper, M Shah, M Lanford, T Philbeck

20. J Vasc Access (published online 8/07/2014) ‘Factors affecting the frequency of vascular access via intraosseous cannulation performed by paramedics in Johannesburg’ Authors: C Vincent-Lambert, A Carpenter

21. Emerg Med J 2012 (29)

22. Recommendations for practice Policies & procedure guidelines Competency based training programs Incorporate into ALS assessments Regular training sessions Use of simulation equipment and scenarios Strong leadership Discussions with pre-hospital colleagues

23. Case Study follow up IO was removed prior to ED discharge Documentation of discomfort at site Unable to discuss with the patient personally Lost to follow up

25. Regional Critical Care Conference April 17 and 18 2015 The Capital Theatre View Street, Bendigo Thank you