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If the patient is ill enough to require an IO chances are they usually don't have 4-5 minutes spare. Especially if they are conscious and in agony. They want their morphine now not 5 minutes later. We got EZ-IO in 2005 with lido but  had lido removed last year so won't know about leaving it for 5 minutes. I thought it would be quicker onset. When I suture or use a digital nerve block I  find lido works very quickly

Then do an IM or IN dose of an opiate to start out. An inhaled agent like entonox (50:50 mix of N2O2 and O2) is a bloody good stop gap while waiting for the IO to sit or IM/IN opiate administration to kick in (if it isn't contraindicated). If they're already in agony for whatever reason giving them one more reason to be in agony is far from a kindness. There are always options including the external jugular (assuming of course that's in your allowed SOP which I suspect it is if your doing nerve blocks and sutures).

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Nerve Blocks and Sutures? That would probably decrease our number of transports a fair bit. 5 minutes is a very long time, but sometimes IO is the only way to go, never want to have an exj as my only option on a 400 pound patient. Unfortunately benzos are not a common option for pain control for us. Our protocol requires at least 2 doses of a narcotic pain killer with no relief (and usually right up to our max dose 250mcg of Fentanyl or 10mg Morphine) before we can request versed or ketamine for pain from our medical control.

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