Hi, we also have intraosseus device available for DR resuscitation and this is part of the regular simulation training. I agree that this does not entirely replace actual use, which is extremely rare but also depending on who is in charge of the situation and what is his/her prior experience. I recall an old study from Canada, where they showed that using it less than once in two years (the frequency may not be accurate) does not alter the proportion of successful attempts compared to those, who use it more. However, people using it more often solved more situations just making more attempts per case.