Intraosseous Administration of Freeze-dried Plasma in the Prehospital Setting

Mor Rittblat*, Lilach Gavish, Avishai M. Tsur, Shaul Gelikas, Avi Benov, Amir Shlaifer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Freeze dried plasma (FDP) is a commonly used replacement fluid in the prehospital setting when blood products are unavailable. It is normally administered via a peripheral intravenous (PIV) line. However, in severe casualties, when establishing a PIV is difficult, administration via intraosseous vascular access is a practical alternative, particularly under field conditions. Objectives: To evaluate the indications and success rate of intraosseous administration of FDP in casualties treated by the Israel Defense Forces (IDF). Methods: A retrospective analysis of data from the IDF-Trauma Registry was conducted. It included all casualties treated with FDP via intraosseous from 2013 to 2019 with additional data on the technical aspects of deployment collected from the caregivers of each case. Results: Of 7223 casualties treated during the study period, intravascular access was attempted in 1744; intraosseous in 87 of those. FDP via intraosseous was attempted in 15 (0.86% of all casualties requiring intravascular access). The complication rate was 73% (11/15 of casualties). Complications were more frequent when the event included multiple casualties or when the injury included multiple organs. Of the 11 failed attempts, 5 were reported as due to slow flow of the FDP through the intraosseous apparatus. Complications in the remaining six were associated with deployment of the intraosseous device. Conclusions: Administration of FDP via intraosseous access in the field requires a high skill level.

Original languageAmerican English
Pages (from-to)591-595
Number of pages5
JournalIsrael Medical Association Journal
Issue number9
StatePublished - 1 Sep 2022

Bibliographical note

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© 2022 Israel Medical Association. All rights reserved.


  • bone injection gun
  • freeze dried plasma (FDP)
  • intraosseous vascular access
  • peripheral intravenous (PIV) line


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