Reducing dose errors for children in cardiac arrest

When children suffer cardiopulmonary arrest (CPA) in the pre-hospital setting, it is particularly important that Emergency Medical Services personnel administer correct medication doses. In a study presented at the 2006 Society for Academic Emergency Medicine Annual Meeting, May 18-21, 2006 in San Francisco, researchers evaluated the change in medication dosing error rates after the Los Angeles County EMS instituted the "LA Kids" program. In that program, paramedics were mandated to use a Broselow tape (a weight-estimating tool) and report weight-based color-codes to the base station. Additionally, base station personnel were taught to use a color-coded dosing chart.

Prior to the "LA Kids" program, during the period 1994 to 1997, only 28% of 104 children with CPA received the correct dose, while 44% received a dose within ±20%. After the LA Kids program was started, in the period 2003-2004, 57% of the children received the exact dose and 70% were dosed within ±20% of the exact dose. Therefore, a child was 3.4 times as likely to receive an exact dose after the program began as before, and was 2.6 times as likely to receive a dose within 20% of the exact dose.

Amy H Kaji MD, states, "Although there are many in the field of pediatric emergency medicine who advocate the use of the Broselow tape for providers, we demonstrate that it is only after Los Angeles County instituted system-wide changes with education that there was any benefit. Merely handing the length-based measuring tape to the paramedics was not enough."

The study is "EMS System Changes Reduce Pediatric Epinephrine Dosing Errors in the Prehospital Setting" by Amy H Kaji MD, Marianne Gausche-Hill MD, Heather B Conrad MD, Kelly D Young MD, William J Koenig MD, Erin Dorsey RN, and Roger J Lewis MD. This paper will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Saturday, May 20, 2006 at approximately 11:45 AM in Salons 1-3 of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.

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