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EZ-IO Gains Popularity; Public Still Wary

ST. PAUL, Minn. -- A new battery-powered drill is helping paramedics save lives, but it also might be scaring patients.

The handheld device makes injecting fluids and drugs quicker during many high-stress emergencies. It s unfamiliar to patients and bystanders, though, so one emergency medical services official is hoping to spread the word about it.

It s important that people understand this, before a medic takes out this Black and Decker-looking thing and they wonder, What in the hell are you doing? said Dr. R.J. Frascone, medical director of emergency medical services for Regions Hospital in St. Paul.

Regions EMS has been involved in early use and research of the so-called EZ-IO, which drills a needle through a soft spot below the knee and creates a port through which medics can inject and withdraw fluids. It s typically used on patients in cardiac arrest or shock, and only then after medics are unable to manually thread needles into the veins in their hands or arms.

Frascone said the drill is gradually becoming a first choice because it s easy and fast. VidaCare, the Texas manufacturer, now counts 1,800 EMS units in the U.S. that use the drill. Medical units in Iraq and Afghanistan are using it more frequently in trauma situations as well.

This device can be the difference between life and death, Frascone said.

Regions in St. Paul wasn t involved in the development or initial federal trials that permitted the device s use, but its medics did a small research study using the EZ-IO and a competing drill called the FAST-1. The medics were more precise with the EZ-IO, using it correctly in 86 percent of attempts, according to results published this summer.

Frascone recently demonstrated on an uncooked chicken leg, drilling into the bone and then leaving behind the inserted needle and port. It took less than 10 seconds. Research studies have shown that medics in the field can use it and have drugs flowing into patients within 60 seconds.

There is a learning curve, however, Frascone said.

Some medics during his study were pushing on the drill too hard, or pulling on it and preventing the needle and port from locking into the bone. When done properly, EMS officials said the drill creates a secure connection that doesn t get jostled when patients are moved and transported to hospitals.

It s like putting a sheet metal screw in a wall, said Dr. Pat Lilja, medical director for North Memorial s emergency medical services. The thing looks like a drill. The company calls it a driver, but it s a drill.

Lilja agreed the device is becoming a first choice for patients in cardiac arrest, because their inactive veins recede and become difficult for paramedics to find. Patients with diabetes often have hidden veins as well.

However, each disposable needle for the drill costs more than $90, so both the Regions and North Memorial medics are told to use them only when necessary.

The traditional method of administering drugs and fluids is called intravenous, or IV, which means inside the vein. The drill uses a different pathway called intraosseous, or IO, which means inside the bone. Either method can be used to administer life-saving drugs such as epinephrine, which boosts the heart rate.

The EZ-IO is but one device in the competitive IO market. WaisMed, also in Texas, sells a spring-loaded gun that lodges a port directly into the bone marrow.

Before these devices existed, medics had fewer options when they couldn t find veins through which to insert IV lines, Frascone said. There were hand-powered IO needles, but they lacked precision and required medics to use considerable force.

Now, some EMS units nationally try IV lines first and switch to the IO drills if they can t find a vein within 30 or 60 seconds. Others use the drills first for cardiac arrest patients. Frascone said his medics use their own discretion, but must make quick decisions and not waste precious seconds.

That s not the way to approach these patients, Frascone said, because they re dying.

Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583.

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