Page 58 - 2022 Spring JSOM

Feasibility of Obtaining Intraosseous and Intravenous Access

Using Night Vision Goggle Focusing Adaptors

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Alexander Iteen, MD *; Eric Koch, DO ; Amanda Wojahn, MD ;
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Ricardo Gutierrez, HMCS ; Amy Hildreth, MD ; Sherri Rudinsky, MD ;
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Travis Deaton, DO ; Gregory J. Zarow, PhD 8
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ABSTRACT
Background: The optimal tactical lighting for performing med- battlefield, IV and IO access are crucial to the resuscitation of
ical procedures under low-light conditions is unclear. Methods: casualties. 1–8
United States Navy medical personnel (N = 23) performed
intravenous (IV) and intraosseous (IO) procedures on manne- Tactical lighting, such as headlamps, is widely used by medi-
quins using a tactical headlamp, night vision goggles (NVGs), cal personnel to deliver care in low-light operational environ-
and night vision goggles with focusing adaptors (NVG+A) uti- ments. Tactical headlamps have advantages, including a wide
lizing a randomized within-subjects design. Procedure success, field of lighting, hands-free operation, and normal visual fo-
time to completion, and user preferences were analyzed using cusing. However, tactical lighting has limited utility when light
analysis of variance (ANOVA) and nonparametric statistics at discipline is paramount.
p < .05. Results: IV success rates were significantly greater for
the headlamp (74%) than for NVG (35%; p < .03) and some- NVGs were developed to preserve distance vision in low-light
what greater than for NVG+A (52%; p = .18). IO success rates conditions while maintaining light concealment. However,
were high under each lighting condition (96% to 100%). Time NVGs were not designed for close-in medical procedures such
to completion was significantly faster using headlamp (IV, 106 as IV and IO access. To perform close-in tasks, the objective
± 28 s; IO, 47 ± 11 s) than NVG (IV, 168 ± 80 s; IO, 56 ± 17 s) lenses of the NVGs need to be refocused, resulting in loss of
or NVG-A (IV, 157 ± 52 s; IO, 59 ± 27 s; each p < .01). Post- distance focus, which can be detrimental in a kinetic envi-
testing confidence on a 1-to-5 scale was somewhat higher for ronment. Empirical studies have demonstrated that medical
NVG+A (IV, 2.9 ± 0.2; IO, 4.2 ± 0.2) than for NVG (IV, 2.6 procedures are feasible using NVGs but that these procedures
± 0.2; IO, 4.0 ± 0.2). Participants cited concerns with NVG+A have a lower rate of success and take longer to complete com-
depth perception and with adjusting the adaptors, and that the pared with conventional procedures. 9–14
adaptors were not integrated into the NVG. Conclusion: While
this mannequin study was limited by laboratory conditions and Focusing adaptors that attach to NVGs have recently been
by the lack of practice opportunities, we found some small ad- developed to allow for near-field focus down to 18 inches
vantages of focusing adaptors over NVG alone but not over while maintaining distance focus out to infinity. However,
headlamp for IV and IO access in low-light conditions. these adaptors decrease the amount of light coming through
the NVGs, potentially reducing efficacy. To our knowledge,
Keywords: low light; military medicine; Special Operations; in- no studies published to date were specifically designed to eval-
travenous access; intraosseous access; night vision goggles; uate NVG+A compared with NVGs alone or tactical head-
focusing adaptors lamps on the success rate or time to completion of any medical
procedure.

To fill this important gap, we conducted a prospective, ran-
Introduction
domized, within-subjects experiment using mannequins to
Military operations are frequently performed at night to pro- contrast NVG, NVG+A, and green-light tactical headlamp
vide a tactical advantage. Close-in medical procedures, such lighting on IV and IO access success rates and times to com-
as IV and IO access, are challenging in low-light conditions. pletion. Our null hypotheses were that there would be no sta-
Because hemorrhage remains the leading cause of death on the tistically significant differences between lighting conditions in
*Correspondence to alexander.iteen@gmail.com
1 LT Iteen is affiliated with the Emergency Medicine Department, Naval Medical Center San Diego, CA, and the Combat Trauma Research Group
West, Naval Medical Center San Diego. LCDR Koch is affiliated with the Emergency Medicine Department, Naval Medical Center San Diego,
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and the Combat Trauma Research Group West, Naval Medical Center San Diego. LT Wojahn is affiliated with the Emergency Medicine Depart-
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ment, Naval Medical Center San Diego, and the Combat Trauma Research Group West, Naval Medical Center San Diego. HMCS Gutierrez is
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affiliated with the Reconnaissance Training Company, School of Infantry (West) (SOI–West), Camp Pendleton, CA. LCDR Hildreth is affiliated
with the Emergency Medicine Department, Naval Medical Center San Diego, the Combat Trauma Research Group West, Naval Medical Center
San Diego, and the Military and Emergency Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, MD. CAPT
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Rudinsky is affiliated with the Military and Emergency Medicine Department, Uniformed Services University of the Health Sciences. CAPT
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Deaton is affiliated with the First Marine Division, I Marine Expeditionary Force (I MEF), Camp Pendleton. Dr Zarow is affiliated with the
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Combat Trauma Research Group West, Naval Medical Center San Diego and with The Emergency Statistician, Idyllwild, CA.
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