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 proficient at rapid IV line placement in the prehospital setting, with little difference between urban and nonurban areas in a geographically diverse state. Design: Prospective evaluation by an in-field observer of timing, sequence, success rates, and patient characteristics for IV line placement by prehospital personnel for 1 year. Setting: Twenty advanced life support agencies from all four emergency medical service regions of Arizona. Participants: Fifty-eight patients encountered by participating emergency medical service agencies who had at least one IV line placement attempt in the prehospital setting. Results: Urban agencies encountered 24 patients (41.4%), and nonurban agencies encountered 34 (58.6%). Fifty-seven of 58 patients (98.3%) had at least one successful IV line started before arrival at a hospital. All 24 urban patients 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 attempts (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 settings (P =.408, power =.7). Thirty of 31 IV line attempts (96.7%) were completed 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 systems (P =.520, power =.13). Mean IV line procedure intervals were 1.3 minutes 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 minutes compared with 1.7 in medical patients (P =.017). Conclusion: Personnel 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 short, and little difference was noted between urban and nonurban providers. IV procedure intervals were shorter for successful attempts, on-scene attempts, and attempts in trauma patients compared with their counterparts. [Spaite DW, Valenzuela TD, Criss EA, Meislin HW, Hinsberg P: A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel. Ann Emerg Med August 1994;24:209-214.].