When paramedics arrive at the scene of an emergency that demands immediate medical intervention, there’s a critical piece of information that we need before dosing any sort of medication, especially for children: the patient’s weight.
Medication dosage, in some instances and conditions, can hinge on fractions of a pound or kilo.
Almost half a century ago, hospital systems got clever and installed weighing systems in the hospital beds themselves, allowing for instant data to respond quickly and safely with proper medical interventions, regardless of a patient’s state.
Almost shockingly, however, this same innovation has never made its way to one of the most time-sensitive settings in medicine: ambulance vehicle beds. Until now.
At Hennepin Healthcare Emergency Medical Services, which services Minneapolis and 13 surrounding communities with a staff of over 300 medical professionals, I serve as the deputy chief of operations. In 2022 we were introduced to a new technology that immediately caught our attention. OneDose, powered by OneWeight, developed by Hinckley Medical.
The system consists of an integrated gurney scale and prehospital dosing app that allows EMS professionals to gather accurate, actual patient weight in the field, eliminating the guesswork, time lost and cognitive calculations.
On one hand, I was so impressed with the technology and on the other hand, couldn’t believe it had taken someone over 50 years to develop. And now, we’re proud to be the first large urban EMS nationwide that’s now equipping our fleet with a weighing system, so that our EMS providers can more confidently tackle every prehospital situation.
Until now, EMS professionals have been left to guess patient weights in the field. These weight-estimation methods rely on ideal body weights to determine dosing. But many (especially pediatric patients) fall outside ideal height-weight ratios. In addition, emergency-services personnel have been required to perform many mental calculations and conversions in high-stress situations. The results because of this are alarming:
- More than 50% of EMS medical errors are due to incorrect weight estimation and cognitive errors.1
- Up to 1 in 3 prehospital pediatric doses are critically incorrect.2
- More than 100,000 adverse patient outcomes are due to prehospital dosing errors each year.3-4
We’re eager to take steps to improve these statistics in Hennepin County, Minnesota, and hope to be a beacon of hope to other communities as we show what’s possible when EMS professionals are better equipped in time-sensitive situations. With the weighing system, our EMS professionals no longer need to rely on obsolete methods, intuition or quick mental calculations to save lives. In addition to dosing more accurately, actual patient weights can be related to hospital personnel from the field – allowing crucial preparation prior to emergency department arrival.
Take the scenario of a patient experiencing a stroke, for instance. While it depends on the type of stroke, a common phrase is “time is brain,” meaning: every second counts. As soon as paramedics establish that a patient is having a stroke, we call ahead to the receiving facility, calling a stroke code so that their team can be ready. Usually, stroke patients go straight to the CT scanner, but part of that process is also mixing up a clot-busting drug called TPA.
For TPA, you must have a very specific patient weight to dose it correctly. I’ve seen it happen where a weight reading of, say, 102.39 kilos produces a different dose ratio than if the patient were 102.45 kilos. Rather than wait until the patient arrives at the hospital to get that precise weighing, by gathering that data in a prehospital setting, the receiving facility can begin preparing the medication ahead of time and move the patient right into imaging, making every second count.
As we roll this technology out to more of our fleet vehicles, we’re identifying ways to operationalize this new solution so that every EMS professional feels equipped to leverage this data faster. Certainly, one way to do that is to ensure consistency from vehicle to vehicle so that EMS professionals know what to expect when they get to work that day and can build the system into their workflow, regardless of which vehicle they are working in. Training and familiarity with new systems is equally important.
In EMS, if we’re not moving forward, we’re moving backward. Including weighing systems in our rigs is just one small way we can ensure patients are provided the best and most precise care possible.
References
1. Hoyle J., Davis A, Putman K, Trytko J, Fales D. (2012) Medication Dosing Errors in Pediatric Patients Treated by Emergency Medical Services, Prehospital Emergency Care, 16:1, 59-66.
2. Ramadanov N, Klein R, Schumann U, Aguilar ADV, Behringer W. Factors, influencing medication errors in prehospital care: A retrospective observational study. Medicine (Baltimore). 2019 Dec;98(49):e18200. doi: 10.1097/MD.0000000000018200. PMID: 31804342; PMCID: PMC6919435.
3. French L. There are 28.5 million EMS dispatches per year across 41 states. EMS1. Available from: https://www.ems1.com/ambulance-service/articles/national-association-of-state-ems-officials-releases-stats-on-local-agencies-911-calls-LPQTHJrK2oIpxuR1/
4. O’Connor P, O’Malley R, Lambe K, et al. How safe is prehospital care? A systematic review. Int J Qual Health Care. Epub 2021 Oct 9. doi: 10.1093/intqhc/mzab138.
