Case for importance of access to intravascular compartment Is intravascular access really important? Assuming that an EMS system could fiat easy and widespread access to the intravascular compartment in an MCI or more routine ALS or BLS response, is there impact on outcome? Unfortunately, as is often the case with EMS interventions, there is little or no randomized controlled evidence addressing the issue - in fact, related literature on penetrating trauma suggests that prehospital fluid resuscitation may be deleterious. However, clinical practice as well as standard emergency medicine and trauma resuscitation teaching (such as the Advanced Cardiac Life Support course and the Advanced Trauma Life Support text) do emphasize importance of early fluid resuscitation for a variety of injuries and illnesses.1 In addition, literature addressing MCI situations (e.g. crush injuries) makes a strong case for the importance of fluid replacement.2 Besides opening an avenue for fluid replacement, catheter-based access to the intravascular compartment allows for reliable delivery of medications. For patients who are not tolerating po intake, or for those who otherwise stand to benefit from parenteral drug delivery, catheter-based access to the intravascular compartment allows for administration of repeated doses of a variety of drugs while avoiding multiple (often painful) injections. Once the catheter is placed (currently, in a vein), the access line is available to both initial and subsequent caregivers.