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Walker D, Moloney C, SueSee B, et al. Prehosp Emerg Care. 2022;Epub Jun 27.
Safe medication management practices are critical to providing safe care in all healthcare settings. While there are studies reporting a variety of prehospital adverse events (e.g., respiratory and airway events, communication, etc.), there have been few studies of medication errors that occur in prehospital settings. This mixed methods systematic review of 56 studies and case reports identifies seven major themes such as organizational factors, equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors, and cognitive factors as contributing to safe medication management.
Bosson N, Kaji AH, Gausche-Hill M. Prehosp Emerg Care. 2022;26:492-502.
Pediatric medication administration in prehospital care is challenging due to the need to obtain an accurate weight and calculate dosing. The Los Angeles County emergency medical services implemented a Medical Control Guideline (MCG) to eliminate the need to calculate the dose of a commonly administered medication. Following implementation of the MCG, dosing errors decreased from 18.5% to 14.1% in pediatric prehospital care.
Siebert JN, Bloudeau L, Combescure C, et al. JAMA Netw Open. 2021;4:e2123007.
Medication errors are common in pediatric patients who require care from emergency medical services. This randomized trial measured the impact of a mobile app in reducing medication errors during simulated pediatric out-of-hospital cardiac arrest scenarios. Advanced paramedics were exposed to a standardized video simulation of an 18-month of child with cardiac arrest and tested on sequential preparations of intravenous emergency drugs of varying degrees of difficulty with or without mobile app support. Compared with conventional drug preparation methods, use of the mobile app significantly decreased the rate of medication errors and time to drug delivery.
Hoyle JD, Ekblad G, Woodwyk A, et al. Prehosp Emerg Care. 2021:1-8.
Inaccurate assessment of pediatric patient weight can lead to medication dosing errors. In simulated pediatric scenarios, pre-hospital emergency medical services (EMS) crews obtained patient weight using one or more of three methods: asking parent, using patient age, and Broselow-Luten Tape (BLT). BLT was the most frequent method used and patient age resulted in the most frequent dosing errors. Systems-based solutions are presented.

James Augustine, MD, is the National Director of Prehospital Strategy at US Acute Care Solutions where he provides service as a Fire EMS Medical Director. We spoke with him about threats and concerns for patient safety for EMS when responding to a 911 call.

Cicero MX, Adelgais K, Hoyle JD, et al. Prehosp Emerg Care. 2020;25:294-306.
This position statement shares 11 recommendations drawn from a review of the evidence to improve the safety of pediatric dosing in pre-hospital emergent situations. Suggestions for improvement include use of kilograms as the standard unit of weight, pre-calculated weight-based dosing, and dose-derivation strategies to minimize use of calculations in real time.   
Hoyle JD, Ekblad G, Hover T, et al. Prehosp Emerg Care. 2020;24:204-213.
Emergency medical technicians (EMTs) often make dosing errors when administering medication to pediatric patients. This study found that in simulations, Michigan's state-wide pediatric dosing reference system reduced but did not eliminate prehospital provider medication mistakes. A PSNet perspective further explores prehospital patient safety.
Misasi P, Keebler JR. Ther Adv Drug Saf. 2019;10:2042098618821916.
This pre–post study reports a decline in medication error rates in prehospital emergency services following implementation of a human factors engineering approach. The providers implemented a team-based cross-check process using standardized communication for high-risk medications and found a significant reduction in medication errors.
Boyle MJ, Eastwood K. World J Emerg Med. 2018;9:41-45.
Safe medication administration in the prehospital setting requires paramedics to rapidly and accurately calculate medication doses. Researchers tested 20 experienced Australian paramedics in a classroom and found that most made errors in dosing or arithmetic. In other studies, human factors engineering approaches showed promise in reducing reliance on mental math.
Hoyle JD, Sleight D, Henry R, et al. Prehosp Emerg Care. 2016;20:117-124.
Medication errors are common in pediatric patients who require care from emergency medical services. This study found that most paramedics had limited experience and comfort in administering medications to children. Investigators identified several remediable barriers to improving medication safety in this setting.
Stevens AD, Hernandez C, Jones S, et al. Resuscitation. 2015;96:85-91.
This randomized simulation study compared paramedics' ability to correctly dose medications for pediatric patients with color-coded prefilled syringes versus traditional medication kits. Researchers found that color-coded prefilled syringes improved dose accuracy and decreased time to medication delivery, demonstrating how a system intervention can enhance clinical performance.

J Health Serv Res Policy. 2015;20(suppl 1):S1-S60.

Articles in this special supplement explore research commissioned by National Institute for Health Research in the United Kingdom to address four patient safety research gaps: how organizational culture and context influence evaluations of interventions, organizational boundaries that affect handovers and other aspects of care, the role of the patient in safety improvement, and the economic costs and benefits of safety interventions.
Lammers RL, Willoughby-Byrwa M, Fales WD. Simul Healthc. 2014;9:174-183.
Simulations of prehospital pediatric cardiopulmonary arrest uncovered many potential errors. Most notably, medication errors related to the correct weight-based dosing of epinephrine were common. This mistake can have serious consequences and warrants further efforts to mitigate this risk.

Brice JH, Patterson PD, eds. Prehosp Emerg Care. 2012;16:1-108.  

This special issue contains articles exploring safety improvement efforts in emergency medical services.
Vilensky D, MacDonald RD. Prehosp Emerg Care. 2011;15:39-43.
This study analyzed communication errors during call bookings for air medical transport and found both human and process-driven root causes. Examples of major errors identified were commissions of allergies to medications and omissions of intubations from records.