“88.8% of paramedics studied reported the need for pediatric drug dosing cards”


Medication errors are common in the prehospital setting due to the complexity of treatment regimens and the hurried environment (1). Pediatric patients are especially at risk due to the extra steps, calculations, and processes involved in pediatric treatment.

The prehospital work environment is typically high-stress and hurried for paramedics. Prompt decision making and treatment with correct therapy is key to managing an emergency properly (1). Unfortunately, the fast-pace and pressure of the prehospital setting make the occupation prone to medication errors (1). These medication errors have significant impacts on patients, families, and the healthcare system (1). Side effects, allergic reactions, overdose, and death are all possible outcomes of a medication administration error (1). Due to pediatric weight and young age, pediatric patients are incredibly susceptible to side effects and overdose.


Paramedics are responsible for the safe administration of the appropriate medications (2). Many different factors can lead to drug administration errors in the prehospital setting (2).

Common medication errors in the prehospital setting include (2):

Pediatric patients are especially susceptible to medication errors (3). The calculations and estimations involved must be entirely accurate to avoid medication administration errors (3). A study by Dr. Richard Lammers included 45 different paramedic crews and sought to identify the root causes of medication error in pediatric patients using simulated emergency settings (3).

The study mentioned above identified a variety of contributing factors, including (3):

The most commonly reported errors were mainly due to problems with calculation abilities and dose identification. These medication errors are preventable with the correct training and tools.









“Simulations can be a positive learning tool. As shown in Dr. Lammers’s study, simulations can identify errors that may not be apparent in a real setting. ”


Medication errors are common in the prehospital setting. While medication administration errors are possible with any patient of any age, pediatric patients are particularly vulnerable because of extra dosing steps and required precautions. All paramedics should take extra precautions with pediatric patient medications to reduce the incidence of preventable errors. It is important to be aware of potential medication administration errors, identify medication errors that do happen, and implement continuing education and competencies to encourage paramedics to stay acquainted with pediatric medication dosing and administration.


1. Crossman M. Technical and Environmental Impact on Medication Error in Paramedic Practice: A review of causes, consequences, and strategies for prevention. Australasian Journal of Paramedicine. 2009; 7(3): 1-10.

2. Vilke GM, Tornabene SV, Stepanski B, et. al. Paramedic Self-Reported Medication Errors. Prehospital Emergency Care. 2006; 10(4): 457-462.

3. Lammers R, Byrwa M, Fales W. Root Causes of Errors in a Simulated Prehospital Pediatric Emergency. Academic Emergency Medicine Journal. 2012; 19(1): 37-47.

4. Misasi P and Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther Adv Drug Saf. 2019; 10: 1-14.

5. Hoyle JD, Crowe RP, Bentley MA, et. al. Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics. Prehospital Emergency Care. 2017; 21(2): 185-191.

6. Wallace M, Tidwell D, Powell E. Paramedic Pediatric Medication Errors and High-Reliability Solutions. UCLA Prehospital Care Research Forum.

7. Stevens AD, Hernandez C, Jones S, et. al. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial. Resuscitation. 2015; 96: 85-91.

Written by Hayden Gharibyar, PharmD for MedCognition

MedCognition created PerSim, the holographic patient simulator made to help you save more lives. EMS EDUCATION/ TRAININGSEPTEMBER 23, 2020