Ep. 164: The Microskills of Pediatric Medication Safety (Crossover with the EMS Clinical Brief podcast)

What does it really take to administer pediatric medications safely in EMS—and what can go wrong even when clinicians use cognitive aids? In this crossover episode, originally recorded for the EMS Clinical Brief podcast, Maia Dorsett interviews Bryan Harmer, a paramedic researcher and expert in pediatric medication safety whose simulation research has directly observed and characterized medication errors. His findings include two important papers recently published in Prehospital Emergency Care. Together, they unpack the often-overlooked microskills involved in pediatric medication administration, from determining weight and calculating doses to preparing, administering, and documenting medications. Drawing on Bryan's research, they explore how seemingly small errors—including incorrect use of length-based tapes, air in syringes, and errors during bedside dilution—can lead to discrepancies between the dose intended, the dose administered, and the dose documented. They also discuss why cognitive aids alone aren't enough and share practical strategies EMS systems can use to identify hidden risks and improve medication safety through simulation, equipment selection, and medication cross-checks. References: Hoyle Jr, J. D., Davis, A. T., Putman, K. K., Trytko, J. A., & Fales, W. D. (2012). Medication dosing errors in pediatric patients treated by emergency medical services. Prehospital emergency care, 16(1), 59-66. Hoyle Jr, J. D., Ekblad, G., Hover, T., Woodwyk, A., Brandt, R., Fales, B., & Lammers, R. L. (2020). Dosing errors made by paramedics during pediatric patient simulations after implementation of a state-wide pediatric drug dosing reference. Prehospital Emergency Care, 24(2), 204-213. Harmer, B. M., Hoyle Jr, J. D., Edwards, A., Fredericks, T., Wells, L., Lecznar, A., ... & Fogarty, K. (2026). Assessing the influence of a statewide dosing reference aid on prehospital pediatric medication dosing errors: a mixed-methods simulation-based investigation. Prehospital emergency care, 30(6), 848-855. Harmer, B. M., Hoyle Jr, J. D., Wells, L., Fredericks, T., Edwards, A., Lecznar, A., ... & Fogarty, K. (2026). A Simulation-Based Root Cause Analysis of Pediatric Medication Dosing Errors in Emergency Medical Services. Prehospital emergency care, 1-9. Dorsett, M., O'Donnell, S., Strickland, W., Cheng, W., Sensenbach, B., Cannuli, M., ... & Cushman, J. T. (2026). Improving pediatric medication safety through implementation of evidence-based guidelines. Prehospital Emergency Care, 1-8.   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Welcome to the Prehospital Emergency Care Podcast! In this episode, hosts Jer Escajeda, Greg Muller, and Ariana Weber discuss four more of the fourteen articles from the Prehospital Trauma Compendium.   In 2025, the Prehospital Trauma Compendium introduced crucial guidelines and insights regarding the management of traumatic injuries in prehospital settings. This episode summarizes four significant articles that focus on special populations: pediatric, pregnant, and geriatric patients, as well as the management of entrapped patients.  If you're an EMS professional or a medical provider involved in trauma care, these insights are vital for improving patient outcomes.  References: Cicero MX, Adelgais K, Funaro MC, et al. Prehospital Trauma Compendium: Pediatric Severe and Inflicted Trauma - A Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. Published online February 10, 2025. doi:10.1080/10903127.2025.2457141 Maloney LM, Huff AN, Couturier K, et al. Prehospital Trauma Compendium: Management of Injured Pregnant Patients- A Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. Published online March 12, 2025. doi:10.1080/10903127.2025.2473679 Haussner WK, Breyre AM, Bascombe K, et al. Prehospital Trauma Compendium: Management of Geriatric Trauma Patients - A Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. Published online September 25, 2025. doi:10.1080/10903127.2025.2557006 Bosson N, Abo BN, Litchfield TD, et al. Prehospital Trauma Compendium: Management of the Entrapped Patient - a Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. Published online October 24, 2024. doi:10.1080/10903127.2024.2413876   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Welcome to the Prehospital Emergency Care Podcast! Rapid seizure termination is one of the most important priorities in pediatric prehospital care, yet establishing intravenous access can delay treatment. In this episode, Maia Dorsett and Joelle Donofrio-Odmann speak with Jonathan Mohnkern about his recent systematic review and meta-analysis comparing intranasal and intramuscular midazolam for pediatric seizures. Together, they review the available evidence, discuss the pharmacologic differences between administration routes, examine the implications for EMS protocols and medication dosing, and explore how these findings may influence future prehospital seizure management.   Featured Article: Mohnkern, J. D., Khalid, A., Ibrahim, M., Dave, V., Chierighini, P. P., Riaño, A. S., ... & Martins Shehan, T. S. (2026). Intranasal versus intramuscular midazolam in pediatric seizure control: a systematic review and meta-analysis. Prehospital Emergency Care, 1-9. https://doi.org/10.1080/10903127.2026.2658592 Additional References: Shah, M. I., Macias, C. G., Dayan, P. S., Weik, T. S., Brown, K. M., Fuchs, S. M., ... & Lang, E. S. (2014). An evidence-based guideline for pediatric prehospital seizure management using GRADE methodology. Prehospital emergency care, 18(sup1), 15-24. Shah, M. I., Ostermayer, D. G., Browne, L. R., Studnek, J. R., Carey, J. M., Stanford, C., ... & Lerner, E. B. (2021). Multicenter evaluation of prehospital seizure management in children. Prehospital Emergency Care, 25(4), 475-486. Remick, K., Redgate, C., Ostermayer, D., Kaji, A. H., & Gausche-Hill, M. (2017). Prehospital glucose testing for children with seizures: a proposed change in management. Prehospital Emergency Care, 21(2), 216-221. Silbergleit, R., Durkalski, V., Lowenstein, D., Conwit, R., Pancioli, A., Palesch, Y., & Barsan, W. (2012). Intramuscular versus intravenous therapy for prehospital status epilepticus. New England journal of medicine, 366(7), 591-600. Mohammed, M. Z., Elagouza, I., El Gaafary, M., El-Garhy, R., & El-Rashidy, O. (2024). Intranasal versus buccal versus intramuscular midazolam for the home and emergency treatment of acute seizures in pediatric patients: a randomized controlled trial. Pediatric Neurology, 158, 135-143.   Further Resources:  Pediatric EMS Podcast: Managing Prehospital Pediatric Seizures: https://naemsp.org/podcast-pediatric-em/expedite-the-route-simplify-the-dose-managing-pediatric-prehospital-seizures/  

Welcome to the Prehospital Emergency Care Podcast! In this episode, Greg Muller discusses the article Promotion of Emergency Medical Services: A National Analysis of Clinician Willingness to Recommend the Profession with authors Jacob Kamholz and Ash Panchal. This article explores a novel approach to assessing EMS workforce sentiment using the Net Promoter Score (NPS). Guests Jacob Kamholtz and Ash Panchal discuss how NPS can serve as a benchmark for EMS career advocacy, workforce sustainability, and future planning, highlighting key findings and implications for EMS leadership. Featured Article Kamholz JC, Gage CB, van den Bergh SL, Riel KM, Powell JR, Panchal AR. Promotion of Emergency Medical Services: A National Analysis of Clinician Willingness to Recommend the Profession. Prehosp Emerg Care. 2026 Feb 20:1-7. doi: 10.1080/10903127.2026.2619038.     As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

   Welcome to the Prehospital Emergency Care Podcast! In this episode, hosts Jeremiah Escajeda, Greg Muller, and Ariana Weber discuss four of the sixteen articles from the Prehospital Trauma Compendium. In 2025, the Prehospital Trauma Compendium introduced crucial guidelines and insights regarding the management of traumatic injuries in prehospital settings. This episode summarizes four significant articles that focus on the use of blood products, vasopressors, tranexamic acid, (TXA), and care for patients in traumatic cardiac arrest. If you're an EMS professional or a medical provider involved in trauma care, these insights are vital for improving patient outcomes.   Featured Articles Brown, J. B., Yazer, M. H., Kelly, J., Spinella, P. C., DeMaio, V., Fisher, A. D., … Guyette, F. X. (2025). Prehospital Trauma Compendium: Transfusion of Blood Products in Trauma – A Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care, 1–10. https://doi.org/10.1080/10903127.2025.2476195 Orpet, R. E., Barrett, W. J., Kaucher, K. A., Colwell, C. B., & Lyng, J. W. (2024). Prehospital Trauma Compendium: Vasopressors in Trauma – a Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care, 1–7. https://doi.org/10.1080/10903127.2024.2437656 Barrett, W. J., Kaucher, K. A., Orpet, R. E., Campion, E. M., Goodloe, J. M., Fischer, P. E., … Lyng, J. W. (2025). Prehospital Trauma Compendium: Tranexamic Acid in Trauma – A Joint Position Statement and Resource Document of NAEMSP, ACEP, and ACS-COT. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2025.2497056 Breyre, A. M., George, N., Nelson, A. R., Ingram, C. J., Lardaro, T., Vanderkolk, W., & Lyng, J. W. (2025). Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest – A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP. Prehospital Emergency Care, 1–15. https://doi.org/10.1080/10903127.2024.2428668   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

  Welcome to the Prehospital Emergency Care Journal Podcast! In this Deep Dive episode, host Maia Dorsett speaks with Aaron E. Robinson, Sarah K. S. Knack, and Michael C. Perlmutter about their paper, Trends in Prehospital First-Attempt Use of Supraglottic Airways in Non-Cardiac Arrest Patients: A Descriptive Study. The conversation explores how airway management in EMS may be evolving, including growing interest in supraglottic airways as a first-line approach rather than solely a rescue device. The authors discuss key airway concepts—such as RSI, DSI, and rapid sequence airway—and review what their national dataset reveals about current practice patterns. Along the way, they examine variations in medication strategies, including the continued use of sedation-only approaches and airway placement without neuromuscular blockade or medications. The discussion raises important questions about how EMS clinicians balance speed, safety, and skill maintenance when managing critically ill airways in the field.   Featured Article Robinson, A. E., Knack, S. K. S., Driver, B. E., Prekker, M. E., Perlmutter, M. C., Bunting, A. J., … Puskarich, M. A. (2026). Trends in Prehospital First-Attempt Use of Supraglottic Airways in Non-Cardiac Arrest Patients: A Descriptive Study. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2025.2593579   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Are you ready for NAEMSP?! In this special edition of the Prehospital Emergency Care podcast, host Greg Muller is joined by Guest Editor Remle Crowe to discuss the journal's latest special issue: "Enhancing Prehospital Care for Patients with Opioid Use Disorder". This episode goes beyond the statistics to explore the deeply human experiences behind the data. The episode features in-depth conversations with leading researchers on the front lines of the crisis: • Bringing Treatment to the Streets: Dr. Andrew Godfrey and Advanced Practice Paramedic Vicki Coles discuss the implementation of a prehospital buprenorphine program in Wake County, North Carolina, sharing lessons on clinician education and the vital role of "buprenorphine champions" in bridging the gap to long-term recovery. • The Pediatric Perspective: Drs. Stephen Sandelich and Garrett Cavaliere reveal surprising findings on how the opioid epidemic affects children and adolescents, discussing how the crisis transcends socioeconomic boundaries and why EMS must shift its approach to screening younger patients. • Innovative Strategies: A preview of the issue's 30 peer-reviewed articles, covering topics from drone-delivered naloxone and natural language processing to the qualitative lived experiences of clinicians facing burnout.   This episode serves as a vital primer for EMS professionals, policymakers, and researchers looking to move from traditional response models toward sustainable, patient-centered pathways for care.   Access the full special edition here: https://www.tandfonline.com/toc/ipec20/29/   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Happy Turkey Day! Join host Dr. Phil Moy as we dive straight into a topic that has "stirred up more conversation than a potluck dinner at an EMS station": the prehospital management of spinal injuries. We are here to highlight the critical manuscript "Prehospital Management of Spinal Cord Injuries, an NAEMSP Comprehensive Review and Analysis of the Literature", a pivotal document within the Prehospital Trauma Compendium. To discuss this hot topic, Dr. Moy welcomes two very special guests. First, we have Dr. John Gallagher, an emergency and EMS physician from Kona, Hawaii, and one of the authors of this comprehensive review. Second, we are thrilled to welcome Dr. Ken Milne, recognized as the podcaster from The Skeptic's Guide to Emergency Medicine. Our goal is to provide an objective discussion about the pros and cons of this manuscript so that you, our EMS clinicians and NAEMSP audience, can make your own informed decisions based on the facts. Featured Article: Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries – A NAEMSP Comprehensive Review and Analysis of the Literature: https://www.tandfonline.com/doi/full/10.1080/10903127.2025.2541258 Link to The Skeptic's Guide to EM review of this paper: SGEM#493: You Can't Hold Me Down with Spinal Motion Restrictions: https://thesgem.com/2025/11/sgem493-you-cant-hold-me-down-with-spinal-motion-restrictions/ As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

  Is Air EMS Overutilized for Kids? Tune in to the latest PEC Podcast! Editors Maia Dorsett and Joelle Denofrio-Odmann sit down with authors Dr. Vishal Naik and Dr. Sriram Ramgopal to unpack their compelling research, "Rapid Discharge Following Air Transport in Children". This multicenter study, published in Prehospital Emergency Care, reveals that more than two-thirds (66.0%) of children transported to the Emergency Department (ED) by air EMS are either discharged directly from the ED (20.0%) or within 48 hours of admission. While air transport is crucial for critically ill children, these findings emphasize the need for additional research into the decision-making processes surrounding pediatric air EMS to support optimal resource utilization and patient care. Dr. Naik and Dr. Ramgopal discuss key factors associated with rapid discharge, including lower triage acuity and certain diagnoses like musculoskeletal and connective tissue diseases. Discover what this high rate of rapid discharge implies for potential over-triage in pediatric air medical transport systems. Read the full article here: https://www.tandfonline.com/doi/full/10.1080/10903127.2025.2531074?src=#abstract.   Featured Article Naik, V., Bhardwaj, P., & Ramgopal, S. (2025). Rapid Discharge Following Air Transport in Children. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2025.2531074 🔗 Read the article: https://www.tandfonline.com/doi/full/10.1080/10903127.2025.2531074?src=#abstract.   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

  Welcome to the Prehospital Emergency Care Journal Podcast! In this PEC Podcast Deep Dive, Rebecca Cash and Maia Dorsett interview Dr. Tony Fernandez about his recent PEC paper comparing initial prehospital adenosine doses of 6 mg versus 12 mg for presumed SVT. We explore the study's origins, dataset design, and results—including the finding that starting with 12 mg was associated with higher rates of cardioversion and fewer redoses without an increase in complications. Along the way, we discuss the quirks of EMS data, why some "standard" practices exist without strong evidence, and how retrospective studies fit into the bigger picture of protocol change. For those whose interest in study methods was piqued, here's a great short primer on odds ratios versus relative risk: https://www.youtube.com/watch?v=dWtzaKYFg00&t=175s Featured Article Fernandez, A. R., Bourn, S. S., Duncan, D., Slovis, C. M., Crowe, R. P., Treichel, A., & Myers, J. B. (2025). Comparing Prehospital Adenosine Initial Dosing of 6 mg Versus 12 mg for Presumed Paroxysmal Supraventricular Tachycardia (PSVT). Prehospital Emergency Care, 1–6. https://doi.org/10.1080/10903127.2025.2504521 🔗 Read the article: https://www.tandfonline.com/doi/abs/10.1080/10903127.2025.2504521   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD