IO, IO – It’s off to work we go!

Intraosseous access is one of those skills that is rarely used but can be a lifesaver. In the critically ill child, IV access can be challenging. You get tunnel vision and try to insert a cannula whilst losing focus on the reason for access – circulatory support. In order to achieve mastery in any skill, one must undertake deliberate practice, using both mental and physical simulation.

Here’s how you can produce your own IO trainer for a few cents:

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	1. You are going to need a couple of delicious chocolate bars, some gloves and  a roll of 15cm wide plaster of Paris.
	2. Keeping the wrapper on the chocolate (you may want to eat it later after  all) apply six to eight layers of plaster and allow to dry.
	3. Here is the completed product.
	4. One of the trainers has been wrapped in an attempt to simulate skin. I  have found that a looser glove works best.  It also makes the trainer easier to  transport without – you no longer cover your clothes in plaster dust.
	5. Unlike the more traditional chicken bones you can have one or two of these  trainers made up in advance for just-in-time teaching.

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This is not a new technique.  It’s even been written up in the literature here.

Bateman ED, Bateman A. Intraosseus access simulation: the Crunchie solution. Emerg Med J. 2010 Dec;27(12):961