Columns, Patient Care

Pediatric Medication Dosage Errors and Paramedic Training Needs

Issue 9 and Volume 42.

Dosage Errors

Hoyle JD Jr, Crowe RP, Bentley MA, et al. Pediatric prehospital medication dosing errors: A national survey of paramedics. Prehosp Emerg Care. 2017;21(2):185–191.

Pediatric patients can be among the most challenging faced by EMS practitioners.

Background: Recent research has found that pediatric patients transported by ambulance have a higher severity of illness and require more medications and procedures than children brought to an ED by a private vehicle.1

Calculating medication doses for pediatrics is known to be difficult, as evidenced by a recent study which found only 51% of seizing pediatric patients received the correct dose of midazolam.2

This new research seeks to quantify the prevalence of pediatric patient medication errors by paramedics.

Methods: This was a cross-sectional analysis of nationally certified paramedics, currently registered with the National Registry of Emergency Medical Technicians (NREMT). The survey tool was developed, then reviewed for readability and interpretation.

The review process included a panel of 10 currently practicing paramedics. A random sample of 10,530 paramedics currently certified by the NREMT was sent an email requesting participation. Two follow-up emails were sent to non-respondents to encourage participation within the study.

Of the 1,043 (9.9%) paramedics asked to participate completed the survey, 1,014 (97.2%) met the inclusion criteria for the study. Descriptive statistics were calculated based upon the results of the survey.

Results: A total of 42.8% respondents included within the study reported they were familiar with a case in which a pediatric patient was given an incorrect dose of medication.

Survey respondents expressed significantly higher levels of confidence with performing dose calculations for adolescent patients compared with school-aged children, toddlers or infants. Another interesting finding was that 35.5% of respondents indicated, “I don’t get a weight, I just give a smaller dose.”

A majority of survey respondents (58.1%) believed they didn’t have enough pediatric training as part of their initial paramedic education. When asked if they care for enough pediatric patients to maintain proficiency, 28.3% of the respondents agreed that they did, while 47.6% reported they didn’t have the exposure necessary to maintain competency.

Discussion: Kudos to the authors for studying this important issue within the EMS profession. This research indicates that a substantial number of paramedics perceive they don’t receive enough education in pediatrics during their initial education nor do they experience sufficient exposure to pediatric patients during their clinical practice.

The combination of not having enough education and experience with pediatric patients provides at least one explanation for why so many medication dosing errors are reported within this study.

Conclusion: These findings should prompt a larger conversation within the profession about standards for both initial and continuing education.


1. Dayal P, Horeczko T, Wraa C, et al. Emergency medical services utilization by children. Pediatr Emerg Care. April 11, 2017. [Epub ahead of print.]

2. Shah MI, Carey JM, Rapp SE, et al. Impact of high-fidelity pediatric simulation on paramedic seizure management. Prehosp Emerg Care. 2016:20(4):499–507.