After checking for allergies and confirming the five rights for a casualty about to get an IM injection, the next thing you need to do is choose a site. The three potential sites are:
The casualty’s injury pattern and other tactical considerations will dictate which site you select. And the site will dictate the length of the injection needle, which is usually 1 inch for the deltoid and 1½ inches for the buttocks or thigh.
Some medications come in a powdered form that needs to be reconstituted (for both IM and IV administration), and each manufacturer will provide recommendations on the type of diluent that should be used in reconstitution. From a planning perspective, make sure you have enough diluent for the medications you bring on a mission. And from a training perspective, practice reconstitution at home station prior to deploying to be familiar with the process and save time on the battlefield.
The next video will go over the details of an IM injection, but there are a couple of points that warrant emphasis:
In the TFC setting, the three analgesia-related medications that are potentially delivered intramuscularly include ketamine, naloxone, and ondansetron.
Currently, auto-injectors for IM medications are not being deployed widely, but as guidelines mature and new products become available, this may be a consideration in TFC. The site selection uses larger muscle groups like the thigh and buttocks, and the process is somewhat simplified as the medication is ready for administration.
The two key points to remember are to keep continuous firm pressure so that the hub of the cartridge maintains contact with the skin and the needle is fully deployed into the muscle group, and to hold it in place for a full ten (10) seconds to ensure there was time for all of the medication to be injected.