New treatment cuts to the marrow

The sight and sound could easily make you cringe.

A paramedic grabs your leg at the calf, holding up your thin-skinned shin, and pulls out a 15-gauge syringe, the same size as the ones used for IVs. After gently pushing through your skin, the needle bumps into your tibia, the bone, and that’s when he begins to drill.

The high-pitched noise might ring in your ear like it does at the dentist, as the needle burrows through your bone. And suddenly, it’s through and into the bone marrow.

A quick release from the drill and the needle, and a second later, a tube is attached to the butt of the syringe, and presto — fluids are flowing into your leg, and medics may have just saved your life.

The process, known as intraosseous infusion, is just the latest way Newport-Mesa firefighters and paramedics are learning how to help patients during a medical emergency in that first golden hour.

When paramedics respond to emergencies, such as a car crash, the situations are always different, and they need to be able to react accordingly. Until recently, paramedics in Orange County faced some limits to giving people fluid and medications at the scene of a critical emergency out of sheer chance.

If a person is obese, veins in their arms may be difficult or impossible to find. Finding veins in small children or someone in shock may prove equally difficult. And if someone is an amputee — which paramedics are seeing more of as people come back from fighting in the Middle East — where do you inject saline, dopamine or atropine to bring up their heart rate?

Intraosseous infusion, or IO, helps with the answer, said Costa Mesa EMS Coordinator Larry Grihalva.

“It is a significant improvement in our ability to administer life-saving fluids and medications,” Grihalva said. “We can give those fluids and medications in the field.”

Sometimes medics would have to just rush the victim to the hospital without saline or drugs if, for whatever reason, they could not give it to the patient intravenously. Now they have another option.

In most cases, the patients are unconscious because IO is used in only the most critical situations, like when a person is nearing cardiac arrest, or when a person’s heart has stopped, said Newport Beach EMS Manager Cathy Ord. If the needle is contaminated, that could also pose a risk for infection in the person’s bone, she said.

Thursday, Grihalva showed Costa Mesa and Huntington Beach paramedics how to use the tools and where to inject it. The ideal spot is the tibia, or shin, Grihalva said.

“Theoretically, you can do this in any bone in the body, but it’s just a big target,” he said.

And while it may sound scary, medics hear it isn’t that painful, no worse than getting an IV put in, he said.

Newport Beach paramedics were the first in the county to implement IO with the rest of the county soon to follow, officials said.