I'm another American paramedic posting for the first time (long time reader). Let me start by saying I don't think you did anything expressly wrong on this call. You accurately recognized an acutely ill child, gathered essential information, and expedited your transport to an appropriate facility with a fast transport time. My familiarity with the British ambulance system is limited at best, you acted as any reasonable BLS crew in the states would have done. In fact, many ALS crews (at least one paramedic) would have acted similarly. That being said, I've always learned to be aggressive in treating patients for exactly the same problem you ran into- the A&E staff had not yet "fixed" your patient after arrival. I learned the hard way several times that arrival at the hospital and the time it takes to address your patient's life threat are often separated by quite a while. That could be a reflection of the abilities of the hospital to which you've taken your patient or it could be a reflection of Murphy's Law (what if there is already a working trauma/code in resus or if the A&E is beyond swamped and there simply isn't a bed available for some time). For these reasons, I probably would have started the IO if I were in your position. That being said, IOs are very common in the US (both manual and drill) and I have trained with them extensively and used them clinically fairly frequently. I think they are a fantastic tool that it not as "scary" as I first thought. Still, you did a good job because you accurately recognized that the infant really needed a hospital more than the back of your ambulance. Similarly, great blog, really interesting read for a fellow EMS professional.