Vascular Access
Obtain IV access at this point during the tactical field care phase.
While ATLS training teaches starting two large-bore (14- or 16-gauge) IV catheters, the use of a single 18-gauge catheter is preferred in the tactical setting.
The 18-gauge catheter is adequate for rapid delivery of resuscitation fluids and medication, is easier to insert, and conserves the supplies in a medic aid bag.
Medics should not start an IV on an extremity that may have a significant wound proximal to the IV insertion site.
If the casualty requires fluid resuscitation and IV access cannot be obtained, sternal intraosseous (IO) access is recommended. One possible IO fluid delivery system is the First Access for Shock and Trauma (FAST1) System. Other extremity IO devices are available, but it should be remembered that the majority of injuries are penetrating lower extremity injuries. Cutdowns are not recommended in the tactical setting as they are time-consuming, technically difficult, and require instruments that in all likelihood will not be available. Medics will most likely not be trained, equipped, or authorized to perform cutdowns.
Obtain IV access at this point during the tactical field care phase.
While ATLS training teaches starting two large-bore (14- or 16-gauge) IV catheters, the use of a single 18-gauge catheter is preferred in the tactical setting.
The 18-gauge catheter is adequate for rapid delivery of resuscitation fluids and medication, is easier to insert, and conserves the supplies in a medic aid bag.
Medics should not start an IV on an extremity that may have a significant wound proximal to the IV insertion site.
If the casualty requires fluid resuscitation and IV access cannot be obtained, sternal intraosseous (IO) access is recommended. One possible IO fluid delivery system is the First Access for Shock and Trauma (FAST1) System. Other extremity IO devices are available, but it should be remembered that the majority of injuries are penetrating lower extremity injuries. Cutdowns are not recommended in the tactical setting as they are time-consuming, technically difficult, and require instruments that in all likelihood will not be available. Medics will most likely not be trained, equipped, or authorized to perform cutdowns.
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