Spotlight on Research

‘Watch where you’re sticking that!’: the ability of paramedics to accurately locate correct anatomical sites for intraosseous needle insertion

Previous studies report high success rates of intraosseous (IO) access, with unsuccessful insertion attributed to incorrect site placement and failure to adhere to anatomical landmarks. Berger et al (2023) conducted a prospective observational study assessing the ability of 30 paramedics based in Pennsylvania (USA) to identify the correct locations for both proximal humeral and proximal tibial IO insertion sites. All participants had been trained in IO insertion, with 57% having completed ten or more IO insertions clinically. Although a high percentage of participating paramedics verbally identify the correct location for IO placement, fewer were able to locate the correct insertion site on a human volunteer.

Participants’ insertion site was compared with the physician-identified ‘correct’ site, via a system of overlay transfers, and distances from the ‘correct’ site were recorded to the nearest 0.5cm. While 26 paramedics (90%) correctly identified both the proximal humerus and proximal tibia, 70% of participants selected a site >2cm from the physician-identified site.