In my county (Suffolk, NY) we cannot perform IO's on adults. We can do SQ, IM, IV, EJ.
We CAN do IO's on infants and children less than 6yo. My instructor told us that he has been doing ALS for 25 years and has never done an IO. I also heard a story about someone who did it "because he could" - he missed, by the way. I would prefer to stick to an IV, and if that doesn't work, throw meds down the tube. It was neat to practice on raw chicken legs though.
We were taught to use the traditional method with starting an adult IO infusion. We used the standard IO needle and inserted it into the bone marrow on the medial prominance of the foot (the little round thing). The lateral prominance also works. Sorry, can't remember the exact bone name.
It was rather easy to perform and provides a quick alternative when IV access cannot be established. We did'nt touch on the sternal IO devices. Once established, it functions just like an IV and the same amount of fluid and drugs can be administered.
Pretty cool, actually and is apart of Maryland protocol. In Pennsylvania, only pediatric IO's are performed.
The state defination of a ped (for IO purposes) is up to 6 years old. However, our medical director has written a variance that allows us to perform these on kids up to 12 years old.
I talked to one of our other intermediate level EMT's, and she told me in 10 years she came close to using an IO on one occassion (and she was scared because the kid was crashing that fast.)
The next county over lets their EMT's do adult IO's in the sternum area using the spider-looking IO device. Basically you place it above the sternum and push, and it anchors itself. I will post a link when I find out exactly which device they are using.
We perform child & adult IO's (in adult: both proximal and distal) and sternal IO's.
I have not performed an IO with the Jamshidi in the field yet, but I will have a cadaver lab in 2 weeks to practice.
We have tried the BIG (bone injection gun). It didn't work very well for us; however, there is some kind of new drill to insert the tibial IO. I guess we're trying that next.
I have done many of the sternal IOs (aka F.A.S.T 1) made by PYNG. They are a great tool to use in an arrest. I can have a line hooked up in seconds.