Height Measurement in the Prehospital Setting

Tape Measure
Starting to measure height and routinely gathering this data may make a material impact on the quality of care delivered in the prehospital setting. (U.S. Air Force photo by Senior Airman Keenan Berry/Released)

Introduction

The importance of accurate height measurement in the inpatient setting has been previously reported. In the inpatient setting, patient height impacts the multiple crucial parameters in the treatment of patients, including drug dosing, calculations of cardiac output, ventilator management and calculation of body mass index (BMI). Despite the importance of accurate measurements, prior research has indicated that height is often inaccurately measured in the inpatient setting and that self-reported measures are unreliable.1-6 While the majority of these calculations are not necessarily relevant in the prehospital setting, the measurement of height still has a number of important implications for prehospital providers. We will discuss why and how height should be more routinely measured in the prehospital setting.

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The Importance of Prehospital Height Measurement

There are three main lines of argument why we propose routinely measuring height in the prehospital setting:

Accurate Demographics Matter

Demographic information is some of the most important information prehospital providers can obtain outside of the clinical care provided. This demographic information is useful in several settings including epidemiology research, forensic investigations (matching patients to EMS records which currently lack height), and communication with inpatient/emergency providers who rely on accurate data being presented to them. While epidemiology research may not seem immediately relevant, researchers need accurate BMI data to accurately measure many topics of relevance to both EMS providers and society at large such as disease prevalence (i.e. hypoglycemia incidence which may be related to BMI), workplace injuries to EMS providers and general population trends. 

Height-Based Medication Dosing

While infrequently relevant to the prehospital setting, there are certain medications in state protocols that rely on height based dosing, the majority of which occur in the pediatric setting.7,8 Without accurately measured and recorded height, accurate dosing is not possible.

Lung Protective Ventilation

In the critical care setting, the use of low-tidal volume/lung-protective ventilation strategies is well established for patients with acute respiratory distress syndrome (ARDS). While not all intubated patients in the prehospital setting are ARDS patients, lung protective ventilation is still an important element of patient safety in the prehospital setting wherever ventilators are used (while Bag Valve Masks are not able to accommodate the delivery of precise tidal volumes, many EMS ventilators are able to deliver more precise tidal volumes). When following the gold standard ARDS-net protocol, tidal volume is measured as cc’s/kg of ideal body weight, which is determined through a measurement of patient height. 

Next Steps

While the measurement of height in the prehospital setting may not be a traditional component of prehospital assessment for all patients, we propose that height become a routinely measured component for patients. Furthermore, we propose that national agencies such as NEMSIS (the National Emergency Medical Services Information System) begin to capture this data when available to ensure this data can be used by researchers and quality experts nationwide. While it may be challenging to obtain height information in some circumstances, such as high acuity of medical illness, major trauma, psychiatric emergencies, or pediatric emergencies, we propose that in the remaining cases, when practical, obtaining accurate height is a crucial component of demographic information that should be routinely captured in the prehospital setting. 

Given the importance of height measurement, we propose various methods of height measurement in Table 1 below. 

While no solution is perfect, starting to measure height and routinely gathering this data may make a material impact on the quality of care delivered in the prehospital setting as well as on the research efforts to optimize EMS wellbeing and operations.

Disclosure: Drs. Fogerty and Kahn disclose equity in Quantum Labs LLC.

References

1.           Geurden B, Franck E, Van Looy L, Weyler J, Ysebaert D. Self-reported body weight and height on admission to hospital: a reliable method in multi-professional evidence-based nutritional care? Int J Nurs Pract. 2012;18(5):509-517.

2.           Dennis DM, Hunt EE, Budgeon CA. Measuring height in recumbent critical care patients. Am J Crit Care. 2015;24(1):41-47.

3.           Hendershot KM, Robinson L, Roland J, Vaziri K, Rizzo AG, Fakhry SM. Estimated height, weight, and body mass index: implications for research and patient safety. J Am Coll Surg. 2006;203(6):887-893.

4.           Hill A, Roberts J. Body mass index: a comparison between self-reported and measured height and weight. J Public Health Med. 1998;20(2):206-210.

5.           Palta M, Prineas RJ, Berman R, Hannan P. Comparison of self-reported and measured height and weight. American journal of epidemiology. 1982;115(2):223-230.

6.           Greenwood JL, Narus SP, Leiser J, Egger MJ. Measuring body mass index according to protocol: how are height and weight obtained? J Healthc Qual. 2011;33(3):28-36.

7.           Heyming T, Bosson N, Kurobe A, Kaji AH, Gausche-Hill M. Accuracy of paramedic Broselow tape use in the prehospital setting. Prehosp Emerg Care. 2012;16(3):374-380.

8.           Lammers R, Willoughby-Byrwa M, Fales W. Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehosp Emerg Care. 2014;18(2):295-304.

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