00:00:39 LAHardwick: Good Afternoon 00:04:11 Louis Gonzales: Thank you all for joining the Prehospital Breakout session. We have some good information to share and will be looking for your input as well. 00:06:03 Jaime Bartell: Use your Length Based tape 00:06:25 L Jay Barrera: 100ml D10 and 0.8ml of Midazolam 00:07:43 Juliana Soriano: 4mg versed 00:08:03 Stephanie Ashford: why would measuring from the bottom make a difference? they are the same length from one end to the other. 00:08:33 Juliana Soriano: 10g glucose 00:09:44 Ryan McCarrick: every 11lb = 5kg so 11=5 22=10 33=15 44=20 55=25 66=30 77=35 88=40 99=45 00:10:00 Jason Mahoney: In shorter children, if you start with the wrong end of the tape, you can end up with a drastically incorrect length/weight. If the child is 18" long, you end up with a different color zone measurement if you measure 18" from the RED end than if you incorrectly measure 18" from the other end. 00:10:53 Stephanie Ashford: ok, I misunderstood what he meant. I thought he just meant starting with the same starting point from the top or the bottom, but you are saying using the wrong end of the tape all together 00:11:31 Christopher Hitechew: A length based tape will give the dose in mg but still requires knowing the concentration you carry to get the correct ml to administer. 00:12:24 Amolo: Do we use D5 or D10 if seizures fails to stop within 4-5mins? 00:12:32 Kevin McEnery: The “Pedi Tape “ gives the ML 00:13:30 Jason Mahoney: The new 2019 Broselow Tape includes mL too, but you do have to be careful about medication concentrations. Really, most of the meds we carry do come in a standard concentration. 00:13:42 Kevin McEnery: Make sure you carry the same concentration 00:13:46 David Gerstner, Dayton MMRS: Stephanie, I heard it the same way you did. I thought he said it would create an error if you started from the feet instead of the head. 00:14:43 Christopher Hitechew: The standard concentration is good if that is the concentration that can be obtained. We have had issues getting medications in the same concentration. 00:15:48 Amies galaxy: but like my child who is 12 weighs 175 lb and is 5'5 would you dose as an adult 00:16:24 Christopher Hitechew: I would Amies 00:17:06 Amies galaxy: that's what I figured but thought I'd ask 00:17:45 Ryan McCarrick: go on protocol but he's 80kg so would probably fall in that usual "or up to adult dose" section most places have (but protocol prevails) 00:17:57 Stephanie Ashford: our system says if they don't fit on the broslow tape, they get adult dosing 00:18:19 Ryan McCarrick: app: Paramedic Protocol Provider (PPP) 00:19:24 Albert Musto: Our system bases our pediatric care around the hand tevy system 00:20:37 LAHardwick: Getting better pediatric care Is difficult in a High volume system. 00:21:58 Michael Poulin: Most hospitals pharmacies buy according to cost and most prefilled are more expensive then files 00:22:27 Stephanie Ashford: we employ rapid cycle deliberate practice model to maximize our face to face ped courses 00:22:53 Ryan McCarrick: Schools and daycares 00:23:59 Christopher Hitechew: Our service area is rural so we see a low number of pediatric patients. We are fortunate to have a pediatric emergency physician heavily involved in our training and protocol development. 00:25:02 Jennifer Rofrano: How do you adapt these when you have multitasker units? As in, our interfacility units do full 911 emergency calls (1 set of protocols) and their next call could be an EMS only PICU/NICU transfer (another set of protocols). We luckily have great support from our children's hospital, but our administration is very budget ight. So training and equipment are always pushed off with the infamous "cost of it all" reason. 00:25:12 Ryan McCarrick: maybe have everyone in your department bring in their kids to do a training lol 😅 00:25:36 Amies galaxy: I do 🤣🤣 00:26:11 Michael Chaffee: Just had this call 00:28:37 janet: We have ben using Handtevy for a few months now. It has been very successful. I think our confidence in dosages has increased. We built training med kits and practice scenarios using Handtevy and all of our crews have had very positive feedback. 00:33:12 Ilse (LACO Fire): in los angeles county, our ems agency created an app with dosage calculations 00:33:26 Marcus Barnes: Safe Dose App and Broselow tape. We also use excel forms with all of our medications in pediatric dosages based on our protocols. 00:34:25 Albert Musto: I think having a medical director that is progressive in their mode is thinking and open to new ideas and suggestions in fine tuning protocol is a huge asset. 00:35:05 Jennifer Rofrano: Thank you!! 00:35:59 Ryan McCarrick: Keep a $5 calculator in the drug bag just in case 00:36:26 Michael Chaffee: Pediwheel? 00:36:38 Stephanie Ashford: we also use a hybrid solution as several have mentioned 00:36:59 Amies galaxy: this is jumping off Christopher's comment I'm also in a very rural area but unfortunately we don't have peds physicians available at our small hospital. there aren't that many peds calls but when there are they are usually bad and lots of times we cannot contact med control by radio or phone and there isn't alot of training done except pals so what would be things we can implement in the prehospital setting to help our providers and also help our small er 00:37:14 Mark X Cicero: Yes Pediwheel: great for quickly determining doses and fits in a cargo pocket 00:37:35 Michael Chaffee: 👍 00:38:46 Albert Musto: I love Handtevy app for smart phones as you can create a new patient profile for each pediatric pt. we encounter and that it keeps a record of it so that it can be referred back to especially useful in the QA/QI process. 00:39:02 Stephanie Ashford: we made a cheat sheet 00:39:22 Michael Poulin: I have no ego to keep from asking my OLMC to check my math at 3am 00:40:07 Ryan McCarrick: That one looks amazing 00:40:33 Jennifer Rofrano: I know for us, due to our PICU/NICU and special needs/chronically ill patient's, the length based dosages may not be appropriate. But for 911, it basically works. Perhaps, it needs to be the upload into a PPP type app on our staffs phone. And yes, it is difficult to "switch gears" several times a day. Thank you for all the suggestions. 00:40:38 Fryman: We are in the process of putting together our entire FD through Handtevy. We have had great buy off from FD Executive Staff as well as the city so far. I feel with that and safety cross checks, it is still fast and safe 00:40:41 Christopher Hitechew: We are working on a medication dosing sheet for pediatric patients. Just not completed. 00:40:56 Jason Mahoney: As part of the PECCLC a couple years ago, Montana put together a bunch of resources. One of them is our Pediatric Scenario Guidebook. Kansas EMSC shared their guidebook, and we added to it. The scenarios it contains are a great way to practice peds care whether they are used as a short tabletop discussion or all the way up to a high fidelity simulation setting. This and other resources are available at: https://1drv.ms/u/s!ApjMd8ty7gsxg7J9-TTCVb1mt64MKA?e=zB6Edi 00:44:53 Jonathan Buesing: Lack of Practice. 00:45:13 Jennifer Rofrano: Fear of being wrong, so they under dose 00:45:14 Albert Musto: Language barriers 00:45:15 Jonathan Buesing: Just low number of detail involving peds 00:45:37 Ryan McCarrick: Extremally easy to follow Adult doses that are basically "one vial of X" 00:46:08 Jonathan Buesing: So crews don't trust themselves, but length based devices and hend tevy have improved this. 00:46:17 Jonathan Buesing: hand* 00:46:30 kathyshear: How to estimate weight of child when parent is not available. 00:46:35 Jennifer Rofrano: Some systems don't have extensive pediatric protocols due to fear of liability 00:46:36 Jonathan Buesing: Buy In from crews 00:46:53 Jonathan Buesing: is a barrier to training.. 00:49:21 Erin Selby: I'd rather have our providers focused on good assessments and critical thinking, then having to do math on meds when time is essential. 00:49:24 Jennifer Rofrano: a non-progressive view of pediatric care, "we didn't do it that way when I was on the road" from upper administration or medical direction 00:49:28 Ryan McCarrick: I am on Long Island in NY where we have like 100 fire districts that all have their own systems but follow the county protocols. Nobody communicates about calls with one another so when X dept has a teachable moment the other 99 departments don't know about it 00:49:44 Michael Chaffee: Time and cost of training, authority to affect change, too many cooks 00:50:49 Michael Chaffee: Breaking the alpha barrier - Buy in 00:51:35 Ryan McCarrick: Using the on-line medical control (call them) to discuss the call to see what the doctor may see 00:51:36 Brian Levinsky: My experience with Broselow bag is there is a lot of management of expiration dates and a large amount of waste, particularly in a large agency. 00:52:00 Erin Selby: Agree with that! 00:52:50 Michael Chaffee: Quartermaster role 00:53:13 Ryan McCarrick: good point lol. we may have a length based tape but if it's from 1985 it will not help much 00:53:48 Mark X Cicero: A quartermaster, and a bounty on expired versions of the tool 00:54:26 Michael Chaffee: Bounty yes! 00:54:41 Ryan McCarrick: break down each bone and work on it 00:56:17 Michael Chaffee: Monthly top to bottom par of each unit. All equipment 00:56:55 Jorie McPartlin - Lifestar EMS: Thank You! 00:56:58 LAHardwick: Excellent information Thank you 00:57:01 Jennifer Rofrano: Thank you 00:57:04 Bradley Starkey: Thank you! 00:57:05 Marcus Barnes: Thank you!!! 00:57:05 Fryman: Thans everyone 00:57:07 Michael Chaffee: Thank you 00:57:08 kathyshear: Thank you 00:57:11 Desiree: thank you 00:57:13 Amolo: Thank you, kwaheri 00:57:14 Taylor Lueking: thank you