Original Contribution Intraosseous line placement for antidote injection by first responders and receivers wearing personal protective equipment ☆,☆☆,★ Stephen W. Borron MD a,g, ⁎ , Juan C. Arias MD a , Charles R. Bauer MD a , Thomas Philbeck PhD b , Patti Hass RN, MSN c , Wayne Lawson PA-C a , Diana Montez RN, BSN b , Miguel Fernández MD a , Inkyung Jung PhD d , Donald J. Gordon PhD, MD e,f a Division of Emergency Medicine and the South Texas Poison Center, Department of Surgery, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA b VidaCare Corporation, San Antonio, TX 78216, USA c Emergency Center, University Hospital, San Antonio, TX 78229, USA d Department of Epidemiology and Biostatistics, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA e Emergency Health Sciences, School of Allied Health Sciences, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA f Emergency Medical Services, San Antonio Fire Department, Bluff Creek Tower, San Antonio, TX 78229, USA g Department of Emergency Medicine, Texas Tech University Health Science Center, El Paso, TX 79905, USA Received 4 February 2009; revised 22 October 2009; accepted 24 October 2009 Abstract Study objective: Early antidotal therapy may be lifesaving in hazardous materials victims. Intravenous line placement is difficult while wearing personal protective equipment (PPE). We assessed the ability of protected, experienced first responders and limited-experience first receivers to place intraosseous (IO) lines for antidote administration. Methods: Six first responders donned 4 (A, B, C, and D) and 12 first receivers donned 2 (C and D) United States Environmental Protection Agency PPE levels in random order and then placed IO lines in 1 of 4 anatomical sites in 12 anesthetized Spanish goats. Observers timed interventions until bolus injection of isotonic sodium chloride solution. ☆ Presentation: This paper was presented at CBMTS VII, Spiez Laboratory, Spiez, Switzerland, on April 15, 2008, and at the American College of Emergency Physicians Scientific Assembly on October 27, 2008. ☆☆ Funding: This study was funded by Merck Santé, Lyon, France, manufacturer of Cyanokit (hydroxocobalamin), and by VidaCare Corporation, San Antonio, TX, manufacturer of the EZ-IO intraosseous needle system. ★ Conflict of interest: Dr Borron has received research funding, consulting fees, and speaker fees from Merck Santé and Dey, LP (which manufactures and distributes hydroxocobalamin, respectively). ⁎ Corresponding author. Department of Emergency Medicine, Texas Tech University Health Science Center, El Paso, TX 79905, USA. Tel.: +1 210 567 5762; fax: +1 210 579 6599. E-mail address: stephen.borron@ttuhsc.edu (S.W. Borron). www.elsevier.com/locate/ajem 0735-6757/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.ajem.2009.10.009 American Journal of Emergency Medicine (2011) 29, 373–381