A PROSPECTIVE IN-FIELD COMPARISON OF INTRAVENOUS LINE PLACEMENT BY URBAN AND NONURBAN EMERGENCY MEDICAL-SERVICES PERSONNEL

Study hypothesis: Emergency medical services personnel are highly prof icient at rapid IV line placement in the prehospital setting, with lit tle difference between urban and nonurban areas in a geographically di verse state. Design: Prospective evaluation by an in-field observer of timing, sequence, success rates, and patient characteristics for IV l ine placement by prehospital personnel for 1 year. Setting: Twenty adv anced life support agencies from all four emergency medical service re gions of Arizona. Participants: Fifty-eight patients encountered by pa rticipating emergency medical service agencies who had at least one IV line placement attempt in the prehospital setting. Results: Urban age ncies encountered 24 patients (41.4%), and nonurban agencies encounter ed 34 (58.6%). Fifty-seven of 58 patients (98.3%) had at least one suc cessful IV line started before arrival at a hospital. All 24 urban pat ients and 33 of 34 nonurban patients (97.1 %) had a successful IV line attempt (P=.586, power =.09). In the urban setting, 24 of 31 attempts (77.4%) were successful, and in the nonurban setting 35 of 52 attempt s (67.3%) were successful (P=.464, power =.28). Mean IV line procedure intervals were 1.6 minutes in urban and 1.4 minutes in nonurban setti ngs (P=.408, power =.7). Thirty of 31 IV line attempts (96.7%) were co mpleted in less than 4 minutes in urban systems, and 49 of 52 IV line attempts (94.2%) were completed in less than 4 minutes in nonurban sys tems (P=.520, power =.13). Mean IV line procedure intervals were 1.3 m inutes for successful attempts and 2.1 minutes for unsuccessful ones ( P=.015). Mean IV line procedure intervals for on-scene attempts were 1 .3 minutes compared with 2.0 minutes for attempts during transport (P= .005). On average, IV line attempts in trauma patients took only 1.0 m inutes compared with 1.7 in medical patients (P=.017). Conclusion: Per sonnel in the 20 advanced life support agencies studied were extremely adept (rate of 98.3%) at obtaining IV line access in the prehospital setting. The time required to complete IV line placement was very shor t, and little difference was noted between urban and nonurban provider s. IV procedure intervals were shorter for successful attempts, on-sce ne attempts, and attempts in trauma patients compared with their count erparts.