What does it really take to administer pediatric medications safely in EMS—and what can go wrong even when clinicians use cognitive aids? In this crossover episode, originally recorded for the EMS Clinical Brief podcast, Maia Dorsett interviews Bryan Harmer, a paramedic researcher and expert in pediatric medication safety whose simulation research has directly observed and characterized medication errors. His findings include two important papers recently published in Prehospital Emergency Care. Together, they unpack the often-overlooked microskills involved in pediatric medication administration, from determining weight and calculating doses to preparing, administering, and documenting medications. Drawing on Bryan's research, they explore how seemingly small errors—including incorrect use of length-based tapes, air in syringes, and errors during bedside dilution—can lead to discrepancies between the dose intended, the dose administered, and the dose documented. They also discuss why cognitive aids alone aren't enough and share practical strategies EMS systems can use to identify hidden risks and improve medication safety through simulation, equipment selection, and medication cross-checks.

References:

Hoyle Jr, J. D., Davis, A. T., Putman, K. K., Trytko, J. A., & Fales, W. D. (2012). Medication dosing errors in pediatric patients treated by emergency medical services. Prehospital emergency care, 16(1), 59-66.
Hoyle Jr, J. D., Ekblad, G., Hover, T., Woodwyk, A., Brandt, R., Fales, B., & Lammers, R. L. (2020). Dosing errors made by paramedics during pediatric patient simulations after implementation of a state-wide pediatric drug dosing reference. Prehospital Emergency Care, 24(2), 204-213.
Harmer, B. M., Hoyle Jr, J. D., Edwards, A., Fredericks, T., Wells, L., Lecznar, A., ... & Fogarty, K. (2026). Assessing the influence of a statewide dosing reference aid on prehospital pediatric medication dosing errors: a mixed-methods simulation-based investigation. Prehospital emergency care, 30(6), 848-855.
Harmer, B. M., Hoyle Jr, J. D., Wells, L., Fredericks, T., Edwards, A., Lecznar, A., ... & Fogarty, K. (2026). A Simulation-Based Root Cause Analysis of Pediatric Medication Dosing Errors in Emergency Medical Services. Prehospital emergency care, 1-9.
Dorsett, M., O'Donnell, S., Strickland, W., Cheng, W., Sensenbach, B., Cannuli, M., ... & Cushman, J. T. (2026). Improving pediatric medication safety through implementation of evidence-based guidelines. Prehospital Emergency Care, 1-8.

As always THANK YOU for listening.

Hawnwan Philip Moy MD (@pecpodcast)

Scott Goldberg MD, MPH (@EMS_Boston)

Jeremiah Escajeda MD, MPH (@jerescajeda)

Joelle Donofrio-Odmann DO (@PEMems)

Maia Dorsett MD PhD (@maiadorsett)

Lekshmi Kumar MD, MPH(@Gradymed1)

Greg Muller DO (@DrMuller_DO)

Ariana Weber MD (@aweberMD4)

Rebecca Cash PhD (@CashRebeccaE)

Michael Kim MD (@michaeljukim)

Rachel Stemerman PhD (@steminformatics)

Nikolai Arendovich MD

Ep. 164: The Microskills of Pediatric Medication Safety (Crossover with the EMS Clinical Brief podcast)

Prehospital Emergency Care Podcast

Ep. 164: The Microskills of Pediatric Medication Safety (Crossover with the EMS Clinical Brief podcast)