Humeral Head Intraosseous Access: Filling the Military Training Gap

Purpose: Traumatic life-threatening injuries often require immediate intravenous access for the delivery of lifesaving fluids and medications. When intravenous access is difficult or impossible to achieve, alternate methods of fluid and medication administration are essential. One method is intraosseous infusion, which is the process of delivering fluids directly into the bone marrow space to provide non-collapsible entry into the circulatory system. Although the U.S. Army has spearheaded the initiative of treating wounded service members on the battlefield by using the humeral head needle, it is at a disadvantage by not having a realistic human anatomical model to train on the device. Military medical providers use live tissue models in the absence of a realistic simulations trainer. Despite the limitations of anatomical variations of live tissue, the U.S. Army weighed the risks and benefits of fielding the humeral head intraosseous needle and placed them into the medical equipment sets worldwide in 2015. Description: The U.S. Army Research Laboratory assessed the scientific and technical feasibility of using a low-cost medical simulator for training military medical personnel and developed a Partial Task Trainer to train the procedure. The research involved performing a comprehensive requirements analysis, identifying current gaps in training and prioritizing capabilities. Results: The research team followed a user centric structured system engineering approach allowing for collaboration between stake holders and the development team to facilitate transitioning the technology. Military and civilian subject matter experts identified training gaps. Research was conducted to define technology requirements that would support training. After conceptual design and prototype development, usability evaluations were conducted at various stages of development to refine the final prototype. Conclusions: Usability evaluations and subject matter expertise support the continuation of phase II prototype production of a partial task trainer for the insertion of a humeral head intraosseous needle.