U.Md. doctor aims to help emergency workers in intense situations
Riding in the back of an ambulance managing a very sick child is far from the ideal time for a paramedic to do math.
But often paramedics must do a few calculations in their heads to determine the correct dosage of medication for the child.
“It’s a setup for a disaster,” said Dr. Morgen Bernius, assistant clinical instructor at the University of Maryland School of Medicine, who says this highly charged setting offers too many opportunities for potentially deadly dosage errors.
Bernius created a simple printed card for all paramedics to carry in the ambulance that lists the exact dosage for the child based on weight. In a study on the tool, Bernius found the errors could be drastically reduced when the math is taken out of the emergency equation.
“My goal is for people to realize this is an issue and [there is a] very easy solution,” she said.
Adults receive the same medication dose regardless of their age or weight, but children are much more complicated. Health workers must convert pounds to kilograms and determine if the medication is given in milligrams or milliliters.
Even the smallest math mistakes can result in big overdoses, Bernius said. A child could be given 1 milliliter of epinephrine, which may look like a tiny dose compared with the adult size of 10 milliliters, but it’s still 10 times too much, she said.
Bernius’ card includes 13 medications found in the ambulance and corresponding doses based on weight, as well as appropriate size of the endotracheal tube used to keep the airway open.
In a test of the card’s effectiveness, paramedic students answered 15 questions. Those who didn’t use the cards for help answered 65 percent of them correctly, and those who used the card answered 94 percent of them correctly.
When calculating the right size endotracheal tube, 98 percent of the group answered correctly with the card, compared with 23 percent who didn’t have help, Bernius found.
Now, Baltimore County Emergency Medical Services requires paramedics to use the cards.
“It’s difficult under the best circumstances to be absolutely accurate, and this tool allows us to take the mouth out of it,” said Baltimore County EMS Capt. Steve Adelsberger.
Doing the math can distract a paramedic from other pressing tasks in what is often a very emotional situation, he said.
“We have to do it right,” Adelsberger said.
Other area children’s hospitals have similar cards, but they include additional information for emergency doctors and health care workers, and aren’t specific to paramedics, said Cynthia Wright-Johnson, EMS for Children program director at the Maryland Institute for Emergency Medical Services Systems, which coordinates EMS providers statewide.
Her organization was “very impressed” with the card, but for it to be required statewide, there must first be an evidence-based field test to support the classroom findings, she said.
“I think it’s a great idea,” she said, “and I think it has worked well.”
