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Adult Intraosseous
Michael Stein MD trauma-list@trauma.orgTue, 14 Jan 2003 23:01:48 +0200
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This is a multi-part message in MIME format. ------=_NextPart_000_00D0_01C2BC20.EB185150 Content-Type: text/plain; charset="UTF-8" Content-Transfer-Encoding: quoted-printable Hello Ken,=20 Justy came home and realized that you sent the message on the list. = Well then, the rest of the lurkers deserve an answer too. Hope I don't = raise to much commotion. Remember, this is raw data with personal = opinions. NOT EBM, at least not for now (sorry Eric). So here goes my = response to K, written earlier today: *************************************************************************= ********* Ken, The fact is true that the EMS (MDA - MAGEN DAVID ADOM - Red Star of = David in Hebrew) have been using the gadget as a phase 1 and 2 studies = for at least a year (or More). =20 They have (official number untill today) - 103 cases documented - and = they believe the manufacturer mentioned 300 because that is what was = ordered from them - I spoke now to one of the chief paramedics of MDA, = collecting the data, and got the data from him. It is TRUE that it is = used now routinely AFTER all other attempts for conventional IV lines = fail and the paramedic thinks he needs a line for medications (CPR, = Pulmonary complications, Rapid sequence intubatin in a combative patien = etc.). Most of the 103 BIGs were performed on patients in cardiac arrest, or = very low GCS (So they never felt a thing). Only about 15 were used on = trauma patients (most of them also in very low GCS and NOT for fluid = administration). We tried it in the military (for Far forward Surgery) and it is one of = the last resort gadgets we carry in special ops. The first time it was = used was in 1994 in South Lebanon, when the chopper could not land for = two hours and the physician under fire could not get a line after = numerous trials (including femoral and subclavian sites). We had a pilot = study (phase 1) for 2-3 years when we let the physicians of the Military = Med Evac units try it in cases they have difficulty obtaining a line in = long evacuations or when they needed to perform intubation and wanted to = infuse IV meds. We never intended it to be used for large fluid = volumes. They used it very rarely (I think 2-3 times in 4 years). Most = Docs there are very experienced so they usually managed to put lines = (some during flight) even when the ground physician failed. I think = several hospitals in Israel have the two types of IO (BIG - Bone = Injector Gun - great name, insn't it?). One type is Blue - for adults, = and the other is Red - for kids under 6. If you use it on a conscious = patient, you are right, it is painfull. However, I used it only twice = in my carrier - in the trauma resus unit or TC as you call it. Once on a = kid and once on an adult. They were both with GCS of 4 (the kid) and 3 = (the adult). I saw another that came to the TRU in complete arrest that = had the IO inserted by the paramedic for intubation. We pronounced him = dead immediately. I believe the EMS (MDA), here, were trying it mainly for MEDICAL = patients (Cardiac and other medical emergencies). When they had many = cases where they needed urgent IV medication and could not obtain a = line. Also, their argument was that in the mass casualties scenario, = during explosions it was quicker to get a line this way. Practically, = in the trauma cases of urban explosions, most patients did not need a = line and the most severe injuries benifited more from the quick = transport to the hospital than from the fiddeling with the IV. None = that I remember came in with an IO. =20 I saw the discussion on the trauma list but refrained from involving = myself since my experience is 2-3 personal cases (My own series of case = after case after case... ;-)) and other hearsay data. Eric Frykberg and = yourself would have crucified me. There is no OFFICIAL stand of the Israeli Trauma Society on the issue. = We never had a formal discussion about it. Every one of the executive = committee of the trauma society Knows the Gadget very well, however, it = was never a BIG (;-)) issue since we very rarely used it. The chairman = of the Isrtaeli Trauma Society (Dr. Michaelson, from the Rambam Med Ctr = in Haifa - the largest Level 1 Trauma Center in Israel) did not want to = refer to medical cases. For trauma, he rarely thinks this is needed. = It's major role, in his opinion (and mine too), is in the mass chemical = warfare incident. Then you have the "Wet" patient syndrome. Having = thorough showering, sweating, drooling, diarrhea, semi concious. No = line can be properly secured with tape in this situation and the BIG = "holds" itself in place. In addition, providers outside the hospital = may need to perform procedures with MOP gear and heavy gloves. The BIG = may be useful then. In this type of doomsday scenario, pain due to BIG = insertion may be of lesser importance. So, to summarise MY oppinion on the issue. * I don't think BIG has a significant role in trauma. Maybe, only in = very rare circumstances. On 1,800 Trauma Patient volume per year I will = probably use it once every year or two !! But YES, I will like to know = I have 1-2 sets on the shelf for extreme situations. * For Peds, I look at it as a more sophisticated IO line than the old = ones we used to pierce in with force. So it has a role in Pediatric = trauma (the Red Version). * It may have a role in the pre-hospital setup for MEDICAL emergencies, = but that's not my expertese. It may help introduce urgend medication to = the blood stream. It makes sense, but of course that is not even Level 3 = evidence. * It is probably most valuable for the Doomsday chemical disaster = incident (again not trauma). Also, gut feeling, and level X evidence = that will not be researced EVER untill the real thing happens. Well, I got carried away with emotions on this issue so I will stop = here. Did I answer your question, though? Mickey ************************************************* Michael Stein MD Director of Trauma, Attending Surgeon Department of Surgery Rabin Medical Center, Beilinson Campus Petach-Tikva, 49100 ISRAEL Tel: +972 3 937-7043 Fax: +972 3 937-7042 E-Mail: mshtein@clalit.org.il ************************************************ > -----Original Message----- > From: KMATTOX@aol.com [SMTP:KMATTOX@aol.com] > Sent: ? ????? 14 2003 16:38 > To: trauma-list@trauma.org > Cc: ??=C3=B7? ????? ?"? > Subject: Re: Adult Intraosseous >=20 > Mickey: To my amazement a large force of people (mostly = manafacturers and pre-hospital providers) have tired to support the use = of interosseous infusors in the field in adult trauma patients. = Several of us have attempted to show that these devices are cruel and = unusual punishment and not needed. =20 >=20 > Now, attached is a support from a person who uses the "Israeli" = experience to support his sales. He quotes that the MDA in Israel uses = this device. One of the benefits of the web is that we can openly check = the accuracy of statements almost instantaneously. Do you know just = who and where interosseous devices are used in Israel. What is the = opinion of the Israel Trauma Society and the trauma surgeons of Israel = regarding these devices, their ease in insertion, their indication, and = their effectiveness. =20 >=20 > k=20 >=20 >=20 >=20 > We are the manufacturers of the automatic tibial IO device - B.I.G. I = am running the company and been watching your views exchange in the past = few days. I wanted to share with you information we have about it. >=20 > =20 >=20 > In the past year, we have been evaluating the use of adult IO in = Israel, together with the Israeli National EMS provider - MDA. = Unfortunately, there is no argue (I hope) about the extensive experience = those people are going through in the past 2 years and their = professionalism. I don=E2=80=99t think there are many if any EMS = providers around the world faced trauma and other situations they deal = with every week. (And let=E2=80=99s hope non of you never will). >=20 > =20 >=20 > MDA decided to evaluate the use of adult IO just because they needed = to provide solution in situation they cannot have IV. They are not using = CVC or Cutdown due to complications you are all aware off.=20 >=20 > =20 >=20 > In the past 1 year, they perform about 300 adults IO=E2=80=99s. These = days they write an article with 93 case reports. On our web site you may = find selected 15 cases at <http://www.waismed.com/data/upl/lib/137.doc>=20 >=20 > =20 >=20 > You may also download PP presentation summarizing the data at . As you = know, the Israeli method in trauma is =E2=80=9CLoad and Go=E2=80=9D what = brings the IO use in trauma to 14% of total use. About 62% of the uses = are for cardiovascular and internal emergencies. >=20 > =20 >=20 > Based on the data they have, the MDA decided to use our product as a = routine. Just to mention, our devices (we have pediatric too) are in use = in many countries and militaries in the world.=20 >=20 > =20 >=20 > ?=20 >=20 > -----Original Message----- > From: trauma-list-admin@trauma.org = [mailto:trauma-list-admin@trauma.org]On Behalf Of KMATTOX@aol.com > Sent: Saturday, January 11, 2003 5:23 PM > To: trauma-list@trauma.org > Subject: Re: Adult Intraosseous >=20 > =20 >=20 > Please go read those articles you posted in support of interosseous. = The papers said one thing and one thing only. It is possible to do = this aggressive act! No randomization, no determination of just who = does and does not need the prehospital infusion of anything, and = certainly no comparision to outcomes in other reported series of trauma = patient, especially hypotensive trauma patients, demonstrating better = outcomes. =20 >=20 > Try again. =20 >=20 > k >=20 >=20 >=20 >=20 ----- Original Message -----=20 From: KMATTOX@aol.com=20 To: trauma-list@trauma.org=20 Cc: mshtein@clalit.org.il=20 Sent: Tuesday, January 14, 2003 4:37 PM Subject: Re: Adult Intraosseous Mickey: To my amazement a large force of people (mostly = manafacturers and pre-hospital providers) have tired to support the use = of interosseous infusors in the field in adult trauma patients. = Several of us have attempted to show that these devices are cruel and = unusual punishment and not needed. =20 Now, attached is a support from a person who uses the "Israeli" = experience to support his sales. He quotes that the MDA in Israel uses = this device. One of the benefits of the web is that we can openly check = the accuracy of statements almost instantaneously. Do you know just = who and where interosseous devices are used in Israel. What is the = opinion of the Israel Trauma Society and the trauma surgeons of Israel = regarding these devices, their ease in insertion, their indication, and = their effectiveness. =20 k=20 We are the manufacturers of the automatic tibial IO device - B.I.G. I = am running the company and been watching your views exchange in the past = few days. I wanted to share with you information we have about it. =20 In the past year, we have been evaluating the use of adult IO in = Israel, together with the Israeli National EMS provider - MDA. = Unfortunately, there is no argue (I hope) about the extensive experience = those people are going through in the past 2 years and their = professionalism. I don=E2=80=99t think there are many if any EMS = providers around the world faced trauma and other situations they deal = with every week. (And let=E2=80=99s hope non of you never will). =20 MDA decided to evaluate the use of adult IO just because they needed = to provide solution in situation they cannot have IV. They are not using = CVC or Cutdown due to complications you are all aware off.=20 =20 In the past 1 year, they perform about 300 adults IO=E2=80=99s. These = days they write an article with 93 case reports. On our web site you may = find selected 15 cases at http://www.waismed.com/data/upl/lib/137.doc=20 =20 You may also download PP presentation summarizing the data at . As you = know, the Israeli method in trauma is =E2=80=9CLoad and Go=E2=80=9D what = brings the IO use in trauma to 14% of total use. About 62% of the uses = are for cardiovascular and internal emergencies. =20 Based on the data they have, the MDA decided to use our product as a = routine. Just to mention, our devices (we have pediatric too) are in use = in many countries and militaries in the world.=20 =20 =C3=82=20 -----Original Message----- From: trauma-list-admin@trauma.org = [mailto:trauma-list-admin@trauma.org]On Behalf Of KMATTOX@aol.com Sent: Saturday, January 11, 2003 5:23 PM To: trauma-list@trauma.org Subject: Re: Adult Intraosseous =20 Please go read those articles you posted in support of interosseous. = The papers said one thing and one thing only. It is possible to do = this aggressive act! No randomization, no determination of just who = does and does not need the prehospital infusion of anything, and = certainly no comparision to outcomes in other reported series of trauma = patient, especially hypotensive trauma patients, demonstrating better = outcomes. =20 Try again. =20 k ------=_NextPart_000_00D0_01C2BC20.EB185150 Content-Type: text/html; charset="UTF-8" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META content=3D"text/html; charset=3Dutf-8" http-equiv=3DContent-Type> <META content=3D"MSHTML 5.00.3315.2870" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY bgColor=3D#ffffff> <DIV><FONT face=3DArial size=3D2>Hello Ken, </FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial size=3D2>Justy came home and realized that you = sent the=20 message on the list. Well then, the rest of the lurkers deserve an = answer=20 too. Hope I don't raise to much commotion. Remember, this is = raw=20 data with personal opinions. NOT EBM, at least not for now (sorry = Eric). =20 So here goes my response to K, written earlier today:</FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial=20 size=3D2>****************************************************************= ******************</FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial size=3D2>Ken,<BR><BR>The fact is true that the = EMS (MDA -=20 MAGEN DAVID ADOM - Red Star of David in Hebrew) have been using the = gadget as a=20 phase 1 and 2 studies for at least a year (or More). <BR><BR>They = have=20 (official number untill today) - 103 cases documented - and they believe = the=20 manufacturer mentioned 300 because that is what was ordered from them - = I spoke=20 now to one of the chief paramedics of MDA, collecting the data, and got = the data=20 from him. It is TRUE that it is used now routinely AFTER all other = attempts for conventional IV lines fail and the paramedic thinks he = needs a line=20 for medications (CPR, Pulmonary complications, Rapid sequence intubatin = in a=20 combative patien etc.).<BR><BR>Most of the 103 BIGs were performed on = patients=20 in cardiac arrest, or very low GCS (So they never felt a thing). =20 Only about 15 were used on trauma patients (most of them also in = very low=20 GCS and NOT for fluid administration).<BR><BR>We tried it in the = military (for=20 Far forward Surgery) and it is one of the last resort gadgets we carry = in=20 special ops. The first time it was used was in 1994 in South = Lebanon, when=20 the chopper could not land for two hours and the physician under fire = could not=20 get a line after numerous trials (including femoral and subclavian = sites). We=20 had a pilot study (phase 1) for 2-3 years when we let the physicians of = the=20 Military Med Evac units try it in cases they have difficulty obtaining a = line in=20 long evacuations or when they needed to perform intubation and wanted to = infuse=20 IV meds. We never intended it to be used for large fluid = volumes. =20 They used it very rarely (I think 2-3 times in 4 years). Most = Docs=20 there are very experienced so they usually managed to put lines (some = during=20 flight) even when the ground physician failed. I think several = hospitals=20 in Israel have the two types of IO (BIG - Bone Injector Gun - great = name, insn't=20 it?). One type is Blue - for adults, and the other is Red - for = kids under=20 6. If you use it on a conscious patient, you are right, it is=20 painfull. However, I used it only twice in my carrier - in the = trauma=20 resus unit or TC as you call it. Once on a kid and once on an adult. = They were=20 both with GCS of 4 (the kid) and 3 (the adult). I saw another that = came to=20 the TRU in complete arrest that had the IO inserted by the paramedic for = intubation. We pronounced him dead immediately.<BR><BR>I believe = the EMS=20 (MDA), here, were trying it mainly for MEDICAL patients (Cardiac and = other=20 medical emergencies). When they had many cases where they needed urgent = IV=20 medication and could not obtain a line. Also, their argument was = that in=20 the mass casualties scenario, during explosions it was quicker to get a = line=20 this way. Practically, in the trauma cases of urban explosions, = most=20 patients did not need a line and the most severe injuries benifited more = from=20 the quick transport to the hospital than from the fiddeling with the = IV. =20 None that I remember came in with an IO. <BR><BR>I saw the = discussion on=20 the trauma list but refrained from involving myself since my experience = is 2-3=20 personal cases (My own series of case after case after case... ;-)) and = other=20 hearsay data. Eric Frykberg and yourself would have crucified=20 me.<BR><BR>There is no OFFICIAL stand of the Israeli Trauma Society on = the=20 issue. We never had a formal discussion about it. Every one = of the=20 executive committee of the trauma society Knows the Gadget very well, = however,=20 it was never a BIG (;-)) issue since we very rarely used it. The = chairman=20 of the Isrtaeli Trauma Society (Dr. Michaelson, from the Rambam Med Ctr = in Haifa=20 - the largest Level 1 Trauma Center in Israel) did not want to refer to = medical=20 cases. For trauma, he rarely thinks this is needed. It's = major role,=20 in his opinion (and mine too), is in the mass chemical warfare=20 incident. Then you have the "Wet" patient syndrome. Having = thorough=20 showering, sweating, drooling, diarrhea, semi concious. No line = can be=20 properly secured with tape in this situation and the BIG "holds" itself = in=20 place. In addition, providers outside the hospital may need to = perform=20 procedures with MOP gear and heavy gloves. The BIG may be useful=20 then. In this type of doomsday scenario, pain due to BIG insertion = may be=20 of lesser importance.<BR><BR>So, to summarise MY oppinion on the = issue.<BR>* I=20 don't think BIG has a significant role in trauma. Maybe, only in = very rare=20 circumstances. On 1,800 Trauma Patient volume per year I will probably = use it=20 once every year or two !! But YES, I will like to know I have 1-2 = sets on=20 the shelf for extreme situations.<BR>* For Peds, I look at it as a more=20 sophisticated IO line than the old ones we used to pierce in with = force. =20 So it has a role in Pediatric trauma (the Red Version).<BR>* It may have = a role=20 in the pre-hospital setup for MEDICAL emergencies, but that's not my = expertese.=20 It may help introduce urgend medication to the blood stream. It makes = sense, but=20 of course that is not even Level 3 evidence.<BR>* It is probably most = valuable=20 for the Doomsday chemical disaster incident (again not trauma). = Also, gut=20 feeling, and level X evidence that will not be researced EVER untill the = real=20 thing happens.<BR><BR>Well, I got carried away with emotions on this = issue so I=20 will stop here. Did I answer your question,=20 though?<BR><BR>Mickey<BR><BR>********************************************= *****<BR>Michael=20 Stein MD<BR>Director of Trauma, Attending Surgeon<BR>Department of=20 Surgery<BR>Rabin Medical Center, Beilinson Campus<BR>Petach-Tikva,=20 49100<BR>ISRAEL<BR><BR>Tel: +972 3 937-7043<BR>Fax: +972 3 = 937-7042<BR>E-Mail:=20 <A=20 href=3D"mailto:mshtein@clalit.org.il">mshtein@clalit.org.il</A><BR>******= ******************************************<BR><BR><BR><BR><BR><BR>>=20 -----Original Message-----<BR>> From: <A=20 href=3D"mailto:KMATTOX@aol.com">KMATTOX@aol.com</A> [<A=20 href=3D"mailto:SMTP:KMATTOX@aol.com">SMTP:KMATTOX@aol.com</A>]<BR>> = Sent: ?=20 ????? 14 2003 16:38<BR>> To: <A=20 href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A><BR>>= Cc: ??=C3=B7?=20 ????? ?"?<BR>> Subject: Re: Adult Intraosseous<BR>> <BR>>=20 Mickey: To my amazement a large force of people (mostly=20 manafacturers and pre-hospital providers) have tired to support the use = of=20 interosseous infusors in the field in adult trauma patients. = Several=20 of us have attempted to show that these devices are cruel and unusual = punishment=20 and not needed. <BR>> <BR>> Now, attached is a support from = a person=20 who uses the "Israeli" experience to support his sales. He = quotes=20 that the MDA in Israel uses this device. One of the benefits of = the web is=20 that we can openly check the accuracy of statements almost=20 instantaneously. Do you know just who and where interosseous = devices=20 are used in Israel. What is the opinion of the Israel Trauma = Society=20 and the trauma surgeons of Israel regarding these devices, their ease in = insertion, their indication, and their = effectiveness. =20 <BR>> <BR>> k <BR>> <BR>> <BR>> <BR>> We are the = manufacturers=20 of the automatic tibial IO device - B.I.G. I am running the company and = been=20 watching your views exchange in the past few days. I wanted to share = with you=20 information we have about it.<BR>> <BR>> <BR>> <BR>> = In the=20 past year, we have been evaluating the use of adult IO in Israel, = together with=20 the Israeli National EMS provider - MDA. Unfortunately, there is no = argue (I=20 hope) about the extensive experience those people are going through in = the past=20 2 years and their professionalism. I don=E2=80=99t think there are many = if any EMS=20 providers around the world faced trauma and other situations they deal = with=20 every week. (And let=E2=80=99s hope non of you never will).<BR>> = <BR>> =20 <BR>> <BR>> MDA decided to evaluate the use of adult IO just = because they=20 needed to provide solution in situation they cannot have IV. They are = not using=20 CVC or Cutdown due to complications you are all aware off. <BR>>=20 <BR>> <BR>> <BR>> In the past 1 year, they perform about = 300=20 adults IO=E2=80=99s. These days they write an article with 93 case = reports. On our web=20 site you may find selected 15 cases at <<A=20 href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-January/3D"http://www.waismed.com/data/upl/lib/137.doc">http://www.waismed.c= om/data/upl/lib/137.doc</A>>=20 <BR>> <BR>> <BR>> <BR>> You may also download PP = presentation=20 summarizing the data at . As you know, the Israeli method in trauma is = =E2=80=9CLoad and=20 Go=E2=80=9D what brings the IO use in trauma to 14% of total use. About = 62% of the uses=20 are for cardiovascular and internal emergencies.<BR>> <BR>> = <BR>>=20 <BR>> Based on the data they have, the MDA decided to use our product = as a=20 routine. Just to mention, our devices (we have pediatric too) are in use = in many=20 countries and militaries in the world. <BR>> <BR>> <BR>> = <BR>>=20 ? <BR>> <BR>> -----Original Message-----<BR>> From: <A=20 href=3D"mailto:trauma-list-admin@trauma.org">trauma-list-admin@trauma.org= </A> [<A=20 href=3D"mailto:trauma-list-admin@trauma.org">mailto:trauma-list-admin@tra= uma.org</A>]On=20 Behalf Of <A href=3D"mailto:KMATTOX@aol.com">KMATTOX@aol.com</A><BR>> = Sent:=20 Saturday, January 11, 2003 5:23 PM<BR>> To: <A=20 href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A><BR>>= Subject:=20 Re: Adult Intraosseous<BR>> <BR>> <BR>> <BR>> Please = go read=20 those articles you posted in support of interosseous. The = papers=20 said one thing and one thing only. It is possible to do this = aggressive act! No randomization, no determination of just = who does=20 and does not need the prehospital infusion of anything, and certainly no = comparision to outcomes in other reported series of trauma patient, = especially=20 hypotensive trauma patients, demonstrating better=20 outcomes. <BR>> <BR>> Try again. = <BR>>=20 <BR>> k<BR>> <BR>> <BR>> <BR>> <BR></FONT>----- Original = Message=20 ----- </DIV> <BLOCKQUOTE=20 style=3D"BORDER-LEFT: #000000 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: = 0px; PADDING-LEFT: 5px; PADDING-RIGHT: 0px"> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A href=3D"mailto:KMATTOX@aol.com" = title=3DKMATTOX@aol.com>KMATTOX@aol.com</A>=20 </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A=20 href=3D"mailto:trauma-list@trauma.org"=20 title=3Dtrauma-list@trauma.org>trauma-list@trauma.org</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>Cc:</B> <A=20 href=3D"mailto:mshtein@clalit.org.il"=20 title=3Dmshtein@clalit.org.il>mshtein@clalit.org.il</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Tuesday, January 14, 2003 = 4:37=20 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: Adult = Intraosseous</DIV> <DIV><BR></DIV><FONT face=3Darial,helvetica><FONT face=3DArial = lang=3D0 size=3D2=20 FAMILY=3D"SANSSERIF">Mickey: To my amazement a large force = of people=20 (mostly manafacturers and pre-hospital providers) have tired to = support the=20 use of interosseous infusors in the field in adult trauma=20 patients. Several of us have attempted to show that these = devices=20 are cruel and unusual punishment and not needed. <BR><BR>Now, = attached=20 is a support from a person who uses the "Israeli" experience to = support his=20 sales. He quotes that the MDA in Israel uses this = device. =20 One of the benefits of the web is that we can openly check the = accuracy of=20 statements almost instantaneously. Do you know just who = and where=20 interosseous devices are used in Israel. What is the = opinion of=20 the Israel Trauma Society and the trauma surgeons of Israel regarding = these=20 devices, their ease in insertion, their indication, and their=20 effectiveness. <BR><BR>k = <BR><BR><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF">We are the manufacturers of the automatic tibial = IO device=20 - B.I.G. I am running the company and been watching your views = exchange in the=20 past few days. I wanted to share with you information we have about=20 it.</FONT><FONT color=3D#000000 face=3DArial lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"> </FONT><FONT color=3D#000000 face=3DArial = lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF">In the past year, we have been evaluating the use = of adult=20 IO in Israel, together with the Israeli National EMS provider - MDA.=20 Unfortunately, there is no argue (I hope) about the extensive = experience those=20 people are going through in the past 2 years and their = professionalism. I=20 don=E2=80=99t think there are many if any EMS providers around the = world faced trauma=20 and other situations they deal with every week. (And let=E2=80=99s = hope non of you=20 never will).</FONT><FONT color=3D#000000 face=3DArial lang=3D0 = size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"> </FONT><FONT color=3D#000000 face=3DArial = lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF">MDA decided to evaluate the use of adult IO just = because=20 they needed to provide solution in situation they cannot have IV. They = are not=20 using CVC or Cutdown due to complications you are all aware off. = </FONT><FONT=20 color=3D#000000 face=3DArial lang=3D0 size=3D3 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT color=3D#000080 face=3DArial = lang=3D0 size=3D2=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"> </FONT><FONT=20 color=3D#000000 face=3DArial lang=3D0 size=3D3 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT color=3D#000080 face=3DArial = lang=3D0 size=3D2=20 style=3D"BACKGROUND-COLOR: #ffffff" FAMILY=3D"SANSSERIF">In the past 1 = year, they=20 perform about 300 adults IO=E2=80=99s. These days they write an = article with 93 case=20 reports. On our web site you may find selected 15 cases at <A=20 = href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-January/3D"http://www.waismed.com/data/upl/lib/137.doc">http://www.waismed.c= om/data/upl/lib/137.doc</A>=20 </FONT><FONT color=3D#000000 face=3DArial lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"> </FONT><FONT color=3D#000000 face=3DArial = lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF">You may also download PP presentation summarizing = the data=20 at . As you know, the Israeli method in trauma is =E2=80=9CLoad and = Go=E2=80=9D what brings=20 the IO use in trauma to 14% of total use. About 62% of the uses are = for=20 cardiovascular and internal emergencies.</FONT><FONT color=3D#000000 = face=3DArial=20 lang=3D0 size=3D3 style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT color=3D#000080 face=3DArial = lang=3D0 size=3D2=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"> </FONT><FONT=20 color=3D#000000 face=3DArial lang=3D0 size=3D3 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT color=3D#000080 face=3DArial = lang=3D0 size=3D2=20 style=3D"BACKGROUND-COLOR: #ffffff" FAMILY=3D"SANSSERIF">Based on the = data they=20 have, the MDA decided to use our product as a routine. Just to = mention, our=20 devices (we have pediatric too) are in use in many countries and = militaries in=20 the world. </FONT><FONT color=3D#000000 face=3DArial lang=3D0 size=3D3 = style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"> </FONT><FONT color=3D#000000 face=3DArial = lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3DArial lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF">=C3=82 </FONT><FONT color=3D#000000 face=3DArial = lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000000 face=3DTahoma lang=3D0 size=3D2 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF">-----Original Message-----<BR><B>From:</B>=20 trauma-list-admin@trauma.org = [mailto:trauma-list-admin@trauma.org]<B>On Behalf=20 Of </B>KMATTOX@aol.com<BR><B>Sent:</B> Saturday, January 11, 2003 5:23 = PM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: Adult=20 Intraosseous</FONT><FONT color=3D#000000 face=3DArial lang=3D0 = size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT=20 color=3D#000080 face=3D"Times New Roman" lang=3D0 size=3D3=20 style=3D"BACKGROUND-COLOR: #ffffff" = FAMILY=3D"SERIF"> </FONT><FONT=20 color=3D#000000 face=3DArial lang=3D0 size=3D3 = style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"><BR><BR></FONT><FONT color=3D#000000 face=3DArial = lang=3D0 size=3D2=20 style=3D"BACKGROUND-COLOR: #ffffff" FAMILY=3D"SANSSERIF">Please go = read those=20 articles you posted in support of interosseous. The papers = said=20 one thing and one thing only. It is possible to do this = aggressive=20 act! No randomization, no determination of just who does = and does=20 not need the prehospital infusion of anything, and certainly no = comparision to=20 outcomes in other reported series of trauma patient, especially = hypotensive=20 trauma patients, demonstrating better = outcomes. =20 <BR><BR>Try again. <BR><BR>k</FONT><FONT color=3D#000000 = face=3DArial lang=3D0=20 size=3D3 style=3D"BACKGROUND-COLOR: #ffffff"=20 FAMILY=3D"SANSSERIF"><BR><BR><BR><BR></BLOCKQUOTE></FONT></FONT></BODY></= HTML> ------=_NextPart_000_00D0_01C2BC20.EB185150--
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