How to start an intraosseous line
Other platforms explain it with text and video. In VMS you practice it on the patient.
When an IV cannot be started in a critical patient, the bone gives fast access.
Step by step
Indication
Critical patient, IV not possible quickly. [1]
Site
Proximal tibia or proximal humerus; avoid fractured or infected bone. [1]
Insert
Clean, insert the needle until a loss of resistance. [1]
Confirm
Needle stands firmly, fluids flow. [1]
Flush
Saline flush; local anesthetic in awake patients per protocol. [1]
Watch
Swelling around the site. [1]
Common errors
- Wrong site.
- No flush.
- Missing extravasation.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic). VMS is not affiliated with these organizations. Updated: 2026-10-11.