Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial

Resuscitation. 2015 Nov;96:85-91. doi: 10.1016/j.resuscitation.2015.07.035. Epub 2015 Aug 3.


Background: Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios.

Methods: We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers.

Results: Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28-39) seconds and 42 (95% CI: 36-51) seconds, respectively (difference=9 [95% CI: 4-14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference=39%, 95% CI: 13-61%).

Conclusions: A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations.

Keywords: Cardiac arrest; Dosing error; Emergency medical services; Medication administration; Pediatrics; Simulation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Intravenous / instrumentation
  • Adolescent
  • Adult
  • Child
  • Color
  • Cross-Over Studies
  • Drug Labeling / methods*
  • Emergency Service, Hospital*
  • Female
  • Heart Arrest / therapy*
  • Humans
  • Male
  • Medication Errors / prevention & control*
  • Medication Errors / trends
  • Patient Simulation*
  • Prospective Studies
  • Resuscitation / methods*
  • Resuscitation / standards
  • Syringes / standards*
  • Time Factors