I second these comments. Particularly with the EZIO, access is less painful than being stuck (possibly multiple times) with a smaller (prob 24ga) catheter, and you have a MUCH better route. Chances are if the child was as sick as you describe, they needed some fluid and fast. You didn't state what the child's vitals were, but given your field impression of 'sick/not sick', it sounds like this kid was in some trouble. That being said, you have to evaluate not just your transport time, but the likely time to DEFINITIVE care. 6 minutes of driving, a bit of time for transfer, and how long in the worst case until the ER gets vascular access ? It has been my experience that hospitals really don't use the IO as much as they could, opting instead for the 'IV Team' or going for an A-line. So the bottom line is - how much could change in your patient in the 10 or so minutes until treatment may be started at the ED ? As we all know, kids can go downhill fast. From my perspective, I'd take a serious look at getting access ASAP since you just don't know, and the sooner the better in a pedi.