- Building collapse (e.g. in an earthquake) with numerous victims in whom simultaneous and timely fluid replacement can stave off crush-mediated renal failure Standard texts such as the American College of Surgeons' Advanced Trauma Life Support note that the need for IV access is often present in cases where there is no ability to place an indwelling vascular catheter. The ATLS text points out that fluid resuscitation in clinically challenging environments (e.g. austere conditions, MCI situations) is often of sufficient criticality that, in the absence of IV access, hydration should be attempted through oral or rectal routes. As the ACS Committee on Trauma writes, oral hydration has obvious aspiration and absorption risks, and rectal clysis (as it is denoted in the ATLS text) presents obvious logistic and patient comfort issues in the field.1 It is thus clear that there is a potential role for EASI access if such access extends the ability to usefully reach the intravascular compartment. In terms of its potential as a mechanism for out-of-hospital fluid replacement and as a route for drug administration, EASI warrants attention in the form of a trial.