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Basic-Level Emergency Medical Technician Administration of Fluids and Glucose via Enzyme-Assisted Subcutaneous Infusion Access

Published online by Cambridge University Press:  05 July 2012

Olanrewaju A. Soremekun ,
Melissa L. Shear ,
Jay Connolly ,
Charles E. Stewart  and
Stephen H. Thomas
Olanrewaju A. Soremekun
Affiliation:
Harvard Affiliated Emergency Medicine Residency Program, Boston, Massachusetts USA Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA
Melissa L. Shear
Affiliation:
Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA
Jay Connolly
Affiliation:
Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA
Charles E. Stewart
Affiliation:
Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma USA Oklahoma Disaster Institute, Tulsa, Oklahoma USA
Stephen H. Thomas*
Affiliation:
Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma USA
*
Correspondence: Stephen H. Thomas, MD, MPH Department of Emergency Medicine University of Oklahoma, School of Community Medicine Tulsa, Oklahoma 74135 USA E-mail [email protected]
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Abstract

Introduction

During disasters and mass-casualty incidents (MCIs), there may be insufficient numbers of advanced life support (ALS) providers to provide intravenous (IV) access to all patients requiring parenteral fluids and/or medications. Enzyme-assisted subcutaneous infusion (EASI) access, in which human recombinant hyaluronidase (HRH) augments subcutaneous fluid dispersion and absorption, may be useful when ALS resources are insufficient to meet intravascular access needs. The utility of the use of the EASI lies, in part, in its ease of placement by ALS personnel.

Objectives

The objectives of this study were to document the feasibility, comfort, and speed/degree of infused-glucose uptake through EASI lines placed by basic-level emergency medical technicians (EMT-Bs).

Methods

Eighteen EMT-Bs instituted EASI access on each other. A total of 150 units (1 mL) of HRH were administered through the EASI line, followed by the administration of 250 mL of tracer-labeled D5W. Timed phlebotomy enabled gas chromatography/mass spectrometry characterization of glucose uptake. Enzyme-assisted subcutaneous infusion placement and comfort ratings were tracked and analyzed using non-parametric statistics and Fisher's Exact Test.

Results

In all 18 subjects, EASI access required only one attempt and was rated by the EMT-Bs as easy to accomplish. Glucose was absorbed quickly (within five minutes) in all subjects. The rate of infusion was rapid (median 393 mL/hour) and was comfortable for the recipients (median pain score 1/10).

Conclusions

The use of EASI may be viable as a fast, simple, and reliable method for the administration of fluid and glucose by EMT-Bs.

Soremekun OA, Shear ML, Connolly J, Stewart CE, Thomas SH. Basic-level emergency medical technician administration of fluids and glucose via enzyme-assisted subcutaneous infusion access. Prehosp Disaster Med. 2012;27(3):1-6.

Keywords

disaster medicineemergency medical servicesfluid resuscitationhyaluronidasemass-casualty incidentprehospitalsubcutaneous infusion
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 3 , June 2012 , pp. 220 - 225
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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