Where is the best location to place an IO if body armor has to be worn?

Placing an intraosseous (IO) line in the humeral head is particularly advantageous in scenarios where body armor is being worn. The humeral head is less likely to be obstructed by armor compared to other sites like the proximal or distal tibia, which can be difficult to access due to the protective gear. Additionally, the humeral head allows for easier access and can provide rapid intraosseous access for fluid resuscitation and medication administration.

This site also has a rich vascular supply, which facilitates effective drug delivery and responsiveness in critically injured patients. The ability to quickly access the humeral head despite restrictive clothing is crucial in tactical and emergency environments, making it the preferred site in such circumstances.

Other sites, such as the proximal and distal tibia, while viable options in general situations, may not be as practical when body armor is involved, as these locations could be hindered by the equipment worn by the individual. The sternal area, while a potential IO site, is not commonly recommended and introduces risks such as complications with the underlying structures. Thus, the humeral head stands out as the best choice in the presence of body armor.