Have We Fixed Dosing Errors in Pediatric EMS?

July 22, 2019

Written by Clay Smith

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Prehospital personnel made frequent pediatric drug dosing errors in several critical scenarios. A drug reference that reduced calculations helped, but the error rate was still dangerously high.

Why does this matter?
Drug dosing errors are common in pediatric patients treated in the prehospital setting. The Michigan prehospital pediatric drug reference aimed to reduce calculations for prehospital personnel and make pediatric drug dosing simpler (see figure below). They color coded it to the Broselow tape, gave both mg and corresponding mL to administer, and required dilution of some drugs to create a different drug concentration that was then transferred to a smaller syringe to prevent giving too much.

Is an order of magnitude that big of a problem?
The authors performed a simulation exercise to test prehospital personnel using the above drug reference in several critical pediatric scenarios. Dosing errors occurred 31% of the time, defined as ≥20% off the appropriate weight-based dose. Compared to before the drug reference, in which errors occurred almost 79% of the time, this was a marked improvement. Ten-fold overdoses still occurred 9% of the time. Pediatric dosing is hard enough. Performing complex dilution calculations is even harder. The key is simplicity. Maybe pre-filled, color-coded syringes would help. However, there is no getting around the need for practice and pre-planning. Apps like Pedi-Stat are also great. But you still have to draw it up correctly and give the right amount. Handtevy is a company that does pediatric prehospital dosing for a living. And there are many more. The Michigan initiative is a step in the right direction. But a 31% error rate is still far too high. This could do serious harm.

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