EMS physician Whitney Barrett joins us to discuss some of the scariest and emotional calls we can go on and how we can manage these situations better. 

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Caring for the critically ill pediatric patient is scary for all emergency providers. We discussed our approach to these calls with attending EM/EMS physician Dr. Whitney Barrett.

Background

• 2015 study: review of trip sheets showed wrong intervention, dosing errors in up to 65% of interventions on pediatric calls

Human Factors

• Potential stressors:

• Math is hard, especially when you’re stressed

• Paradigm that “pediatric patients are not small adults” may lead providers to overthink resuscitation

• System 1: unconscious, second nature

• System 2: conscious, requires mental effort and focus

• If we exhaust system 2 with calculations, we can’t effectively focus on patient care and scene control  

• How can we turn system 2 thinking into system 1 thinking?

• Don’t automatically “load and go”

• Early ventilations and compressions—not early transport—save lives

Solutions

• Cheat sheets: have a pocket reference with normal pediatric vitals and doses by volume, which may be specific for your system. Using this sheet on every peds call you run—whether or not you need it—will help familiarize you with its contents for when you really need that info.

• Handtevy: estimated weight, vitals, doses, and necessary equipment separated by age. Used by the Denver Health Paramedic Division.

• Broselow Tape: estimated weight, vitals, and doses listed on a length-based measuring tape. Designed for hospital use, EMS doses often much higher. Old school pearl: tape it flat to the pram so it’s ready for the patient.    

• PediStat App

• Pearl: age correlates very well with weight, and parents often know the weight!

Takeaways

• Prehospital management of critical pediatric patients needs improvement

• Pediatric reference systems help minimize system 2 thinking and should be used whenever possible.

• Math is hard, and cheating should be encouraged. Have a cheat sheet and familiarize yourself with it.

• On the way to the call, consider differentials and treatment plans.

Sample Cheat Sheet

• This Handtevy “badge buddy” doesn’t have vitals, but it does have estimated weight by age, doses by volume, and airway adjunct sizing. It’s also color-coded and easy to follow.