The kids were severely hurt, and the resources James Kempema had to help them weren鈥檛 what he might have wished for.
An emergency physician from Austin, Texas, Kempema was working a shift at a small rural hospital in Smithville, 40-some miles away. Its emergency department had five beds, its emergency staff just two nurses. Both were dedicated caregivers, but neither was overly experienced with caring for badly injured pediatrics.
The children were siblings who鈥檇 been in a car crash. Their parents, also badly injured, were headed to the regional trauma center by air. The kids, initially assumed dead, were extricated, found to have survived and went to the local shop. One, a boy of around 5, was critical, with evidence of TBI and hemorrhagic shock.
Experienced physicians don鈥檛 like these situations much more than prehospital providers, and for similar reasons.
鈥淭here鈥檚 a lot of provider anxiety in taking care of pediatric patients because, No. 1, just having children in their care is somewhat rare,鈥� said Kempema, M.D., also a veteran EMS doc. 鈥淣o. 2, there are nuances to the dosing parameters they鈥檙e faced with, and trying to remember the dosing guidelines as well as doing the math in their heads and drawing up the appropriate amount of medication can be difficult. And then No. 3, there are extrinsic factors that can have a direct impact on their relationship with the patient 鈥� namely parents or caregivers who can be distraught and make care more challenging.鈥�
These factors can make caring for children in any venue a daunting experience with a high risk of errors. If you want to court a mistake, just try rushing through rapid drug calculations and administrations while patients scream and cry and agitated adults hover and pepper you with questions.
On that night in Smithville, however, Kempema simply pulled out his phone, opened an app and entered a weight estimate for his young patient. In seconds, that provided the care team with appropriate dosages for the medications they鈥檇 need and sizes for the necessary equipment. This allowed the team at the small, rural ED to quickly deliver the best possible care for the child, minimizing any risk of error, before they sent him on to the pediatric trauma center.
鈥淭he staff there didn鈥檛 see pediatric patients like this on a regular basis and weren鈥檛 really prepared or equipped for it,鈥� Kempema recalled. 鈥淚 left my phone next to the child鈥檚 head and was able to get our medications and equipment 鈥� doses for intubation, endotracheal tube size, the depth I needed to go, our ventilator settings. I had to initiate blood products and give a number of other medications as well. The app worked out incredibly smoothly for that and reassured me it was really a useful product.鈥�
A VERSION FOR EMS, A VERSION FOR YOUR AGENCY
The app to which Kempema turned that night in Smithville was , and he was familiar with it because he created it. It鈥檚 been available since 2009, and now a new version has been developed specifically for prehospital users.
Pedi STAT helps caregivers determine those pediatric medication doses and equipment sizes quickly and accurately, providing results at a touch in both calculated doses and volumes. Other features help estimate burn sizes and provide fluid resuscitation rates, toxicology guidelines and more.
For Kempema, the need for such a resource became apparent soon after he completed his residency and started working in pediatric emergency care. 鈥淚t was mostly in my brain,鈥� he recalled, 鈥渂ut I would develop little cheat sheets and spreadsheet guidelines for myself that were basically age- or weight-based and would help me recognize what was the appropriate-size equipment or medication dose.鈥�
A few years later, Apple released the iPhone and gave developers a platform to turn such crib notes into far more functional apps. Kempema created Pedi STAT with a goal of helping the full spectrum of those who care for kids, from EMTs and paramedics to ED teams and hospital personnel in areas like intensive care, surgery and anesthesia. The platform has grown steadily since, adding medications, concentrations and corresponding volumes, and other attributes to enhance providers鈥� care.
While similar challenges, and opportunities for error, afflict all those caregivers above, they are perhaps most acute in the field, where family behaviors are most emotionally charged, and scenes can be uncontrolled. Pedi STAT EMS is a dedicated new spinoff app focused on just the medications and equipment used in the prehospital setting.
With Pedi STAT, users simply obtain the child鈥檚 age, weight or height/length using any common color-based tape and choose the condition they want to treat. With Pedi STAT EMS, that first step won鈥檛 be required: An integrated in-app measuring feature will do it for them. Either app will then instantly return calculated doses for needed medications, as well as volumes to give.
For EMS providers, this can provide some security in the most frenetic moments.
鈥淲ith dosages, there may be an incorrect volume drawn up because that鈥檚 one more math step that has to take place in that high-stress environment,鈥� Kempema explained. 鈥淲e wanted to eliminate that as much as possible. Obviously, you鈥檒l still know you鈥檙e taking care of a child, and you can鈥檛 remove factors like distraught parents or family members. But we want to allow the provider to focus as much as possible on the care of the patient and remove some of these other extrinsic variables.鈥�
Pedi STAT EMS will also soon be customizable to individual EMS agencies, reflecting their preferred medications, dosages and concentrations. Pedi STAT鈥檚 dosing recommendations are guided by an in-house team that includes a pair of pharmacists, as well as input from pediatric emergency docs. However, EMS agencies may have medical direction with different preferences. Individualized versions can be built around their unique protocols.
鈥淎 drug like Versed may come in three or four different concentrations,鈥� Kempema said. 鈥淚f you look up a dose for seizure, it may say to give 2.5 milligrams, but for each concentration it will give you the exact volume to provide. The customized version for EMS agencies will reflect the volume they carry 鈥� we remove some of the extra data that can potentially cause confusion.鈥�
Both apps are available via the Apple App Store and Google Play. Another subsidiary app, Pedi STAT PLUS, is under development as an advanced subscription-based model for hospital users.
BURN GUIDANCE AND A BIG PARTNERSHIP
The notable functions of and Pedi STAT EMS don鈥檛 stop there. Another newly expanded capability aids the care of burn victims. Typically those who care for such patients must perform a rough calculation of the total body surface area (TBSA) burned, generally using the Rule of Nines. Pedi STAT includes a breakdown of those body zones with sliders to estimate their burned portions and achieve a more accurate result.
For example, 鈥淢ost burn charts estimate the patient鈥檚 arm at 9% of their total body surface,鈥� said Kempema. 鈥淲ell, maybe only half the arm is burned. So you would take the slider to roughly 50% on the arm, and it will use that to calculate the percentage relative to the overall total body surface area.鈥� In other words, it will count the half-burned arm as a more accurate 4.5%, rather than the full 9%. Then the app will provide fluid resuscitation volumes and rates.
Other useful content includes guidance for the management of respiratory illnesses. Pedi STAT and the customizable Pedi STAT EMS are also priced at a more affordable point than major competitors, making them viable options for small or cash-strapped organizations.
And beginning this year, Pedi STAT will be integrated within the popular from AcidRemap, LLC, which offers offline digital reference versions of EMS agency protocols.
Under this collaboration, users of the app will be able to search and confirm their agencies鈥� protocols. The app will be customized to reflect their relevant guidelines, dosing parameters and carried concentrations. In an instant they鈥檒l get the right guidance for caring for kids within their system.
Said Kempema, 鈥淲hen a provider is reviewing the protocol 鈥� as an example, say pediatric seizure 鈥� and the dosing calls for some Versed, they can just click on the medication calculator, which will launch Pedi STAT and give them the appropriate dosing under their protocol. The Paramedic Protocol Provider app is used extensively throughout the U.S., so I believe this to be a really nice addition to their product as well as enhance the use of Pedi STAT.鈥�
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