Medic One Pediatric (MOPed) cards: standardising paramedic paediatric resuscitation

Abstract

ObjectivePaediatric resuscitation is highly stressful, technically challenging and infrequently performed by paramedics. Length-based equipment selection, weight-based medication dosing and less familiar paediatric clinical scenarios create high cognitive load. Our project aimed to decrease cognitive load and increase paramedic comfort by providing standardised paediatric resuscitation cards across an entire Emergency Medical Services (EMS) system.MethodsAfter 2 years of collaboration between EMS and regional paediatric subspecialists, we created and implemented a novel set of length-based, colour-coded cards: Medic One Pediatric (MOPed) cards. MOPed cards standardise the approach to paediatric scenarios, such as rapid sequence intubation (RSI), seizure management and cardiac arrest. We standardised drug concentrations across all five EMS agencies to allow for volume-based dosing, removing medication calculations, simplifying the process of medication administration and potentially decreasing both calculation error and time to intervention. We consolidated medications on MOPed cards to the 12 most commonly used in Paediatric Advanced Life Support scenarios. We surveyed 240 EMS personnel before and after implementation to determine use and effect on paramedic comfort.ResultsAfter 12 months of implementation, 97% of respondents reported using the new cards as their primary reference, and 94% reported improved speed and accuracy of medication administration. Specifically, RSI medication administration received the greatest improvement in comfort (p=0.001). Additionally, paramedics increased the use of MOPed cards when selecting endotracheal tubes: 45% of the respondents had done so by 6 months, and 60% had done so after 12 months of implementation (p=0.01).ConclusionsMOPed cards were well adopted across a large EMS system, with improvement in paramedic comfort in managing some paediatric resuscitation scenarios.

Examining Cognitive Aid Use in Emergency Medical Services

“…Since high cognitive load can increase stress (Brachten et al, 2020), the cognitive offloading these aids offer may decrease stress associated with pediatric care. This is supported by Woods et al (2019), which found that using a specifically developed cognitive aid for pediatric emergencies improved paramedic comfort levels in managing pediatric patients.…”

“…Numerous cognitive aids have been found to reduce error and improve patient outcomes in medicine (Arriaga et al, 2013;Hall et al, 2020;Haynes et al, 2009). Additionally, using a cognitive aid during emergencies can improve the comfort level of EMS clinicians rendering care for pediatric patients (Woods et al, 2019). Some EMS medical oversight agencies promote the use of cognitive aids for specific interventions.…”

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries

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Mixed‐methods pilot study exploring the influence of the novel Paediatric Anaesthetic Drug Solution tool on clinician cognitive load during simulated paediatric rapid sequence intubation in the emergency department

“…13 Paediatric RSI has both large intrinsic and extraneous loads, with a higher proportion of nonautomatic actions (reduced automaticity due to the higher intrinsic load), 14 and a large emotional burden associated with caring for a sick child. 15 Additional cognitive load also comes from being rare events. 12 There is a consensus in the literature that medications in paediatric RSI are a large source of stress and error, and there is no universal approach for medication preparation and delivery in resuscitation.…”

“…The ED is also a dynamic, rapid paced setting where time pressures and frequent distractions can impact on an individual's mental capacity (cognitive load) 13 . Paediatric RSI has both large intrinsic and extraneous loads, with a higher proportion of non‐automatic actions (reduced automaticity due to the higher intrinsic load), 14 and a large emotional burden associated with caring for a sick child 15 . Additional cognitive load also comes from being rare events 12 …”