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Emergency Medicine

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A color-coded tape helps EMTs calculate the correct epinephrine dose for children in cardiopulmonary arrest

Children who suffer cardiopulmonary arrest outside the hospital are three times more likely to receive the correct dose of epinephrine from emergency medical technicians (EMTs) when EMTs are required to use a color-coded tape that helps calculate the correct medication dose, according to a new study. In 2001, the Los Angeles County Emergency Medical Services Agency mandated that, as part of its LA Kids Program, paramedics would use the Broselow tape to quickly identify the correct medication dose to give to children in emergencies. The Broselow tape measures a child's height in color zones that correlate with body weight. In this way, the tape helps EMTs to rapidly estimate a child's body weight, calculate weight-based drug doses (children's doses are based on body weight), and choose the correct size of resuscitation equipment for children.

The Agency also provided EMTs with precalculated drug dosing charts organized according to the same color zones as the tape. EMTs were required to report the color zones to trained personnel at hospital bases, who relayed back the proper drug dose. However, paramedics could administer the first dose of epinephrine before hearing from the hospital. The researchers examined the epinephrine dosing of children 12 years or younger who suffered prehospital cardiopulmonary arrest and received prehospital epinephrine treatment by paramedics from 1994 to 1997 (pre-LA Kids) and 2003 to 2004 (post-LA Kids).

Only 29 of 104 children in the 1994-1997 group received the correct dose of epinephrine, and 46 of 104 children received a first dose within 20 percent of the correct dose. During the 2003-2004 period, children were three times more likely to receive the correct dose of epinephrine: 21 of 37 children received the correct dose of epinephrine, and 24 of 37 received a dose within 20 percent of the correct dose. The study was supported in part by the Agency for Healthcare Research and Quality (HS09166).

More details are in "Emergency medical services system changes reduce pediatric epinephrine dosing errors in the prehospital setting," by Amy H. Kaji, M.D., M.P.H., Marianne Gausche-Hill, M.D., Heather Conrad, M.D., and others, in the October 2006 Pediatrics 118(4), pp. 1493-1500.

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