Hello, I'm an Advanced Care Paramedic in Ontario, Canada. I have been lucky in my career to never have had to place an IO in a child, ever! I thought a lot about your call and how I would have handled it myself, had it been me in the "hot seat". My standing orders allow for the placement of an IO in a "pre-arrest" child (which from your description seems to describe this infant!) without needing to look for IV access first... After much thought I think that I would do a rapid eval. for IV access and if nothing is seen/palpated I would then make one IO access attempt on scene prior to transport. my rationale for this is based on the small amount of time needed to assess for, and access an IO as well as the potential benefit to the patient by starting a fluid bolus early. Should the patient deteriorate further, having the IO in place will increase survivability by allowing early drug administration. While I agree that a short transport time is a mitigating circumstance unexpected delays can and will occur. I believe that it's best practice to anticipate at least 3 steps ahead and be prepared for possible deterioration...