When emergency crews respond to calls with a child needing an urgent medication, those first responders quickly need to calculate an exact dosage amount – based on age and weight.
Later in June, the Spokane Fire Department is set to launch the Handtevy system with tools adapted to pediatric calls, which occur infrequently among all emergencies yet often are the most stressful for paramedics and emergency medical technicians. Trainers say Handtevy helps tap answers and right-sized equipment in seconds, versus minutes, including dosages that differ depending on ages – from preemies to teenagers.
On some calls, a baby might need a breathing tube or other medical equipment, in sizes that are miniscule compared with those for adults. The department recently purchased the system from the Handtevy company for $25,000.
It includes color-coded pediatric equipment and supplies in separate pouches by different age groups, books for pediatric care and a mobile phone app – all customized to apply Spokane County medical protocols. It helps EMTs and paramedics rapidly to confirm care and dosages.
“The drugs that we carry require a lot of calculation, and for adults, it’s pretty straightforward,” said Mike Lopez, SFD integrated medical services manager.
“With children, you are required to do some fairly rapid and very accurate math in order to administer the appropriate dose of a medication. That in and of itself isn’t challenging, but now you lump in that you’re dealing with a very small child who is acutely ill, and you may or may not have parents or adult witnesses who are extremely emotionally distraught.
“So, you’re in a very stressful situation, and, all of a sudden, you’ve got to calculate in your mind how much of what medication you’re going to give, and that creates the potential for error if you’re not being very, very careful.”
For all of 2021, Lopez said SFD cared for 1,244 pediatric patients younger than 17, which was about 3% of total patient care during that same period.
“You have a low frequency of occurrence because we don’t see that many severely ill or injured pediatric patients, and then it’s a highly stressful situation. This Handtevy system of care is a very broad-based application of the care that we provide to pediatric patients – from medications to the specialized equipment that we would use – breathing tubes, IVs, the amount of fluid that you would administer to a child, and that’s based on weight and age.”
During May, the SFD is training its staff on use of Handtevy before the system is rolled out to stations. All its firefighters are EMT-trained, and the department has about 64 paramedics.
Handtevy was developed by a Florida pediatric emergency medicine physician, Lopez said.
As an example of a call using the system, he said EMTs might need to apply a breathing treatment to a severely asthmatic child. At a button push, the app can display an age-weight medication dose and correct nebulizer size, along with amount of oxygen.
“We don’t have to fumble around with all of our equipment to find the right-sized widget,” Lopez said. “We can administer that breathing treatment much faster, which in turn improves the outcomes of patients.”
Department members also can use Handtevy after a call to download its information and patient treatment in its electronic records.
Kurt Vande Vanter, SFD medical services officer, said that Handtevy helps streamline emergency pediatric patient care, and he gave an example of quick access to airway equipment for an unconscious child. For a preemie, the length might be an inch and a half compared with 4 to 5 inches for an adult, he said.
Equipment in appropriate sizes – separated in the system’s pouches by age groups – include breathing tubes, IV catheters, syringes to draw up medications, blood pressure cuffs and pediatric stethoscopes.
“Everything is much smaller; it’s really geared toward the pediatric patients in these bags that have the equipment,” he said.
“It takes out a lot of the math of medication dosages. Everything is weight-based for a kid, so what this program does is it goes by age, then it factors in an ideal weight, and we dose off of that. It gives a specific volume for that age group instead of us having to do a math equation in our head, and that’s what takes a lot of stress out of treating a pediatric patient.
“What we are encouraging is for caregivers to stay on scene and provide care. In instances of cardiac arrest, they found in a study that the peak best outcome is when you spend about 20 to 25 minutes on scene treating a cardiac arrest pediatric patient than it would be showing up and five minutes later taking them to the hospital.”
As crews assess the pediatric patient, Vande Vanter said most of the time an adult is present – parent, caregiver or teacher. That adult is typically distraught and might not know the age or the weight information.
“There is this large amount of stress that comes with treating these patients, and then you also have this challenge where this critical patient who is a pediatric patient now has to get these lifesaving drugs, but they’re all weight-based, so we have to give x amount of milligrams per kilogram. This system takes all that guesswork out.”
Since 2018, the Spokane Valley Fire Department also has used Handtevy, specifically now its app, tape measurement and book specific to county medical protocols to confirm pediatric equipment and dosages. The department eventually stocked its own pediatric box, said John Leavell, SVFD division chief of EMS.
“The bag system is great initially, and we had a color-coded bag system, but those calls are few and far between being that most children are healthy, and they don’t have disease processes, so a lot of equipment expires before you can use it,” Leavell said.
“At the same time, we developed our own pediatric box. We have all the equipment that’s in those color-coded bags in our pediatric box.”
Leavell agrees that the system and tools such as the app streamline responses for child emergencies.
“We call that a low-frequency, high-stress call, so having the app, plus a tape, plus the book just ensures we’ll be applying the right equipment, the right interventions for that patient. Like a pilot, we want a checklist so we don’t do something wrong.”
After the initial purchase of equipment and system, the annual Handtevy cost for SFD is expected to be about $3,000, Lopez said. Funding to buy the Handtevy system came from an allocation of funding from the Spokane City Council and will be maintained with the support of the EMS Levy, according to a SFD news release.
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