Teaching an old dog a new trick

Recently I had the opportunity to participate in interosseous catheter placement training.  For those of you who don’t know what this is, it’s like an IV but placed directly in a bone for patients in which rapid treatment is required and IV access cannot be obtained quickly.  The training was funded through an Idea System Innovation Fund grant request submitted by Adam Katz, PA-C.  The Resuscitation Committee noticed that in patients requiring resuscitation in the Acute Care and Critical Care setting, there was often a delay in getting lifesaving medications to them because of the time it took to get an IV.  We know that our paramedics, who face this problem regularly in the field, solved it by switching to interosseous catheters for cardiac arrest patients.

I atteED_Blog_030619nded the training because I wanted to see this Innovation Fund grant in action, but also wanted to make sure I was up to date in my training and use of these special catheters in the emergency department.  There are two important lessons that I walked away with. The first is that paramedics perform the lion-share of these and not physicians or advanced practitioners. For anyone who has tried to place an IV in the field – especially if you’re bouncing around in the back of an ambulance – you know just how hard it is, so our paramedics are the best at this and they lead the training. 

We had two paramedics, Charlie Pim and Jonathon Martin, who were at least 20 years younger than me, teaching Dr. Craig Lilly, a full professor of medicine and one of the most accomplished critical care physicians in the country, and the CEO, a full professor of emergency medicine, how to do the procedure. Charlie and Jon did a great job with us – thanks guys. Ralph Waldo Emerson once said,  “In my walks, every man I meet is my superior in some way, and in that I learn from him. Despite my years of practice, Charlie and John are my superiors when it comes to placing interosseous catheters.  It’s also important to remember and make sure that every member of the team can contribute when trying to solve a problem – you might be surprised at where the best solutions come from. 

The second big learning for me: Best practices in this procedure have probably been updated several times since I first learned how to do it 25 years ago. Yet I have always considered myself an expert in interosseous catheter placement.  One of  the purposes of modern medicine is to constantly pursue new and better ways to deliver health care for patients. I learned something during this training that I missed 25 years ago. This new insight will be better for my patients and it will make me a better physician.

I mention this because I want to relay to all of us who consider ourselves experts,  the importance of retraining for procedures in the medical school’s iCELS learning and simulation center.  Please take advantage of every bit of training they offer and be open minded to the fact that you might not be up to date on best practice.

As we continue our journey to become one of the safest hospitals in America, know that every member of the team has something to contribute – and we all have some knowledge gap to fill.

Thanks for being open minded and learning from one another and, as always, taking great care of our patients and one another,


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