Handtevy

What does 97% correct pediatric medication dosing actually look like?

It looks like a 12-agency EMS system in New York that refused to stop asking hard questions.

Before implementing Handtevy, their dosing accuracy was 79%. Midazolam for pediatric seizures? Correct only 65% of the time. These weren't careless providers. These were dedicated paramedics and EMTs working in a system that hadn't yet given them every advantage possible.

So they changed the system.

They didn't just roll out new technology and move on. They built a culture of continuous improvement:
✅ Monthly case review to understand exactly where and why each error occurred
✅ Distinguishing between "no access to the tool," "had access but didn't use it," and "used it but the display created confusion"
✅ Acting on each failure category differently, with targeted solutions

When midazolam dosing changed from 0.1 to 0.2 mg/kg IM/IN and errors crept back in, they didn't blame providers or pile on more training. They looked at the interface itself, redesigned how the preferred route was displayed, and watched accuracy recover.

That's what rigorous, humble, data-driven EMS medicine looks like.

The result? 97% correct pediatric medication dosing, the highest ever reported in peer-reviewed EMS literature. For a 9-year-old in the back of an ambulance at 2am, that difference is everything.

The question worth asking in your own system isn't "are we doing well enough?" It's "how would we even know, and what would we do about it?"

That's the standard these providers set. And it's one any system can pursue.

Read the full study:https://media.handtevy.com/website/Improving-Pediatric-Medication-Safety-Through-Implementation-of-Evidence-Based-Guidelines.pdf

Every EMS crew has given nitro hundreds of times.

We place a 0.4 mg tab under the tongue. Patient says "ahhh, better." We feel good. We helped.
But here's what a study of 70,890 chest pain patients across 2,119 EMS agencies just found:

Zero difference in preventing bad outcomes.
→ Same rate of CPR
→ Same rate of defibrillation
→ Same rate of cardioversion
→ Same rate of antiarrhythmic drugs
→ Same rate of transcutaneous pacing

Nitro group: 0.17% bad outcomes.
No-nitro group: 0.18%. Statistically identical.

The researchers used clone-censor weighting, a sophisticated method specifically designed to eliminate confounding and immortal time bias. This wasn't a simple comparison. They worked hard to find an effect. They didn't find one.

Even in suspected STEMI patients, where reducing cardiac workload should matter most, the signal didn't reach significance.

Worth noting: the point estimates in STEMI patients trended toward benefit, and the authors plan to study that subgroup further.

That's an honest finding, not a dismissal.

So what does this mean practically?

Nitro still relieves pain. That matters. But for years, our culture has assumed it prevents arrhythmias and saves lives in the back of the truck.

This data doesn't support that assumption.

It also raises a harder question: why do we reach for nitro before considering other analgesics?
Pain management is the goal. The tool should match the evidence.

The authors are transparent about the limitations. The composite outcome was rare, which limits precision. Residual confounding is possible.

This is one study, not a closed case.

But it's a well-designed study asking a question that needed to be asked. And the answer deserves an honest conversation.

Have you ever had a chest pain patient deteriorate right after nitro? What did you think caused it?

Read the full study:https://media.handtevy.com/website/A-Target-Trial-Emulation-of-Prehospital-Sublingual-Nitroglycerin-Administration-for-Suspected-Acute-Coronary-Syndrome.pdf

25 𝐲𝐞𝐚𝐫𝐬 𝐨𝐟 𝐞𝐯𝐢𝐝𝐞𝐧𝐜𝐞. 𝐈𝐭'𝐬 𝐭𝐢𝐦𝐞 𝐭𝐨 𝐫𝐞𝐭𝐡𝐢𝐧𝐤 𝐬𝐩𝐢𝐧𝐚𝐥 𝐢𝐦𝐦𝐨𝐛𝐢𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐄𝐌𝐒.

Since Hauswald's pivotal 1998 Malaysian study, we've had a quarter century of data pointing in the same direction. The evidence against routine spinal immobilization is substantial:

→ No demonstrable benefit in any study
→ Consistent evidence of harm: respiratory compromise, pressure ulcers, increased pain
→ Zero cases where withholding immobilization led to legal liability
→ Multiple cases where applying immobilization caused legal problems

The Wilderness Medical Society's 2024 guidelines, developed by a multidisciplinary team including orthopedic surgeons and EMS physicians, recommend against routine immobilization for suspected spinal injury.

So where does that leave us practically?

Personally, I'm not advocating for removing collars entirely. I'm advocating for using them selectively, based on clinical judgment. A stepwise approach, where paramedics can clinically clear the c-spine in the field, can eliminate the collar in roughly 80% of cases that would have received one under a reflexive protocol. The collar remains available for patients where clearing isn't possible.

The honest reality: the medicolegal concern keeping many of us from changing practice is, per the authors, a shibboleth grounded more in culture than evidence.

EMS culture adds interventions easily. Removing them, even with overwhelming evidence, is far harder.

The authors ask: "How many patients need to be harmed?"

What does your service's spinal management protocol look like today? This is a conversation all of us will benefit from, including our patients.

-PA

Read the full study:https://media.handtevy.com/website/Out-of-Hospital-Management-of-Suspected-Spinal-Cord-Injuries-How-Much-Evidence-Does-it-Take-to-Change-Practice-.pdf

Handtevy has arrived at First There, First Care/Gathering of Eagles 2026!! 🚨⚡️

🔥 Stop by Booth #620 and see how one dashboard gives you total control over your entire clinical ecosystem—protocols, pharmacology, and everything your clinicians see at the point of care.

Interested in becoming a certified Handtevy Instructor? Join us from 8AM-5PM. Last minute spots are still available for just $299!

👉 Register here >> https://courses.handtevy.com/event-directory/handtevy-instructor-course-26/