Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

A Pediatric Bag Separate From the Adult Gear

 

Why do some squads carry their ALS pediatric gear in a separate bag?

Most claim that kids are special and need their own special bag for their own special equipment. They do need special equipment, but it doesn’t need to be stored separately, unless you want to find out how to try to force adult equipment into a small child or infant. This will not go smoothly.

Kids are not just little adults, but the best way to deal with this is to train, get experience treating children, focus on the basics, and have the pediatric equipment available when bad things happen unexpectedly.

But some squads carry all of their ALS pediatric gear in a separate bag.

The pediatric endotracheal tubes, pediatric laryngoscope blades, IO (IntraOsseous) needles, meconium aspirator, and the length based resuscitation tape[1] weigh about a pound.

There is no good reason to separate airway equipment intothe stuff you have when you need it and the stuff that you left in the truck.

What about pediatric dextrose and pediatric bicarb?

You can take an adult syringe (50 ml) of either drug and squirt half out, from a bag of saline draw up enough to return the volume to 50 ml. Tada! Half strength dextrose or half strength bicarb. You can administer this the way the length based resuscitation tape directs for D25W and for 4.2 % Sodium Bicarbonate (adult concentration is 8.4%).

You don’t even need to be good at math to do this. Waste half of the syringe. Refill the part you wasted with saline from an unused IV bag of normal saline (0.9 % saline in water).

What about the difference in cost? The adult syringe contains so much more than the pediatric syringe. You must be wasting a lot of money.

The adult 50 ml syringes cost about the same amount as the pediatric 10 ml syringes. There is extra cost for the IV bag, but you can have that bag running into the child and then there is no extra cost. Or were you planning on giving these very slow IV push, with intermittent aspiration to assure patency, drugs without an IV present?

But the syringe is so much bigger and the markings are much less accurate.

You can clean the plunger with alcohol and use a 10 ml syringe with a needle to draw the amount you need out of the 50 ml syringe. Or you can give a little less than the indicated dose – you can always give more.

So, why do some squads carry all of their ALS pediatric gear in a separate bag?

“Kids are easy to take care of and they can wait until we get to the truck to do that stuff.”

“Carry almost an extra pound? Are you trying to kill ME?”

“I’m so good, I can get away with anything.”

“It’s all in how you document it.”

“We know what we need because dispatch tells us.”

“Like medical command is going to find out?”

So, the 60 year old difficulty breathing patient really is 6 years old and somebody made a mistake about the age, that never happens?

The unknown adult emergency would never really turn out to be a child?

Or, you work in a fly car system and the burned out idiot you relieve never brings the pediatric gear on adult emergencies. When you meet that medic at the hospital, he never has the pediatric bag. Why would he need to? You are protected by a magic force field that prevents you from receiving pediatric calls until you get back to the truck.

Every time you put pediatric gear in the “adult” bag, burned out idiot removes it. Management refuses to act. Nobody at the hospital thinks it is worth doing anything about.

The good news was that the little kid already had extensive rigor mortis.

Updated footnote 02-27-11.

Footnotes:

[1] I wrote about the length based resuscitation tape here, and not yet about the rest:

More Bad Airway Instruction.

.

Comments

  1. I suppose next you will be advocating letting them drink from the same water fountains and eating at the same restaurants. 😉

  2. Let’s not get too aggressive there. We don’t want to upset the status quo.

  3. Interesting stuff…I like the backstage look at paramedic life…

  4. Thank you,I like to point out that we aren’t necessarily smarter than anyone else, just more dangerous. Backstage, offstage, . . . 🙂

  5. Good post…One of the first things I did at the service I work for now was pull the pedi bag off the truck and put what I needed in the ALS bag.

  6. SJ,Thank you. I think that some services carry gear in a separate bag that is worth having. And it can be one place to put a bunch of stuff that is necessary for state inspections. I don’t mind if such a bag exists – as long as the important pediatric equipment is present in the adult bag. I don’t doubt that you understand this, but I was having trouble putting the words together in a sensible way to properly respond.It is just as bad for some of these services to go to a call carrying only the pediatric bag.

  7. When I became an EMS Lieutenant, one of my first actions was to remove the pediatric bag. I always agreed that it was ridiculous to carry all of the peds equipment separately. However, it was not even a full 24 hours before other ALS providers started crying about it. I tried to tell them that it wasn’t a big deal to add an extra handle and a couple blades to the intubation kit, that all the meds we needed were already in the adult bag, and that the braslow tape isn’t exactly heavy, but they wouldn’t hear it. I continued to try to explain the logic behind it for about 2 weeks, before they finally decided to buy a brand new peds bag.

  8. Apparently logic is a foreign language to many people in EMS. Good research is ignored because people “just know” that treatment X works, even though it can be shown to be useless, or even harmful.Tradition is the enemy of progress.

  9. I am a Paramedic in the UK and I work on a response car. We respond to emergencies quicker than an ambulance and provide ALS support whilst waiting for BLS back up (usually BLS where I work as all the paramedics are on cars!)I carry all my kit in one bag and am not stupid enough to give a child an adult dose or try and put an adult sized ET tube into a child.If I fail to take all the equipment I need to a job then I face losing my paramedic licence so why keep it all in seperate bags and risk leaving something in the car/truck?I can work out the dosages/sizes easily as I have a field pocket guide so why would I be concerned about math?

  10. Anonymous,I carry my own length-based resuscitation tape in my pocket, just so I do not have to try to calculate anything when dealing with an unstable child. The push by PALS (Pediatric Advanced Life Support) to calculate things is something i do not understand. I am good at math, but I am still human and capable of making a simple calculation error that might be significant.As much as this seems obvious to you and to me, there are plenty of people here in the US, who just refuse to carry the extra weight. I think some are obsessed with organization. Having a distinctly different pediatric bag helps them to feel more in control of things, even though it has the opposite effect in practice.In EMS we do not always think rationally.

  11. I dug this jewel up and thought I would add my own $0.03 worth even though it is an oldie (but a goodie).I like having everything (as much as possible) in one place. Like you say, we are not talking about a lot of space or weight. Small handle, blades, four to six tubes, IO needle…..But there is that concept that paramedics cannot intubate anymore, so lets dumb it down even further.I would really like to just have a little 'peds pack' in with my regular carry-in bag so I would have it all.The only problem is here in my system, the powers that be have us all with 'standardized' bags in our system (across the five agencies) and they all have to be the same. We cannot modify them, change the contents…The biggest problem I have with it is that we have a medical bag (IV/IO stuff, drugs, medical stuff), airway bag (D cylinder, Kings, BVMs, BP cuff, steth, miscellaneous airway related stuff), peds bag (color coded pouches, IV/IO stuff, medical stuff, more drugs, peds airway stuff, peds BP cuffs, stethoscope, OB kit). Then there are 'back-up' drug boxes (my agnecy has one, other agencies have it divided between two- 'medical' and 'cardiac'), ET kit on the ambulance (heaven forbid we actually practice our skills- we would rather do that 'in the truck').I agree, we do not need a separate peds bag. It's like a security blanket to cover up a lot of other issues.

    • You all have made good points but you can not carry everthing you could possibly need in one bag unless its the size of a truck. We have a first in bag that has O2 ,trauma supplies, airway kit adultand pedi,AED,and BVM, then we have a med bag with all meds and IV supplies and a pedi wheel and we have a pedi bag it is geared with equipment that is for pedis infants and neonate pt only we have an OB kit in this bag also because most people forget that a preg. female can turn into multiple pts real quick. We can work with 2 bags but three is alot better. But I do agree that airway kits should cover all ages and med bags cover all ages . Now that said to help keep from getting caught in a bad situations.expect the worst on every run.

  12. A couple nits to pick after a big Kudos to RM as usual for a great post.

    Firstly, the Laryngoscope handle that takes AA batteries is not a “pediatric” handle, it’s just a handle that takes AA’s not C’s. Nowadays you can get many different handles with different options but they make no difference in the actual intubation. You can carry the AA handle and stick a Mac4 on it and tube Andre the Giant night and day. You can put a Miller0 on your C handle and tube a premie too. I like having both in my tube kit but if it came down to carrying that stuff a long distance the C handle would be gone along with 3/4 of the blades. On that topic why do we carry so many tubes? Are half-millimeter increments necessary? Doesn’t matter if you want .0 or .5 at the end, I’d even be ok with skipping 2 sizes at a time. Would anyone feel grossly inadequate with a kit of just 2.5, 4.0, 5.5, 7.0 & 8.5 tubes or some close variation? There seems to be this need to have so much equipment in a bag that rarely gets used for more than one patient at a time.

    When I went to paramedic school there were 6 bags in the bus: drug restock bag, BLS check out bag (a case of equipment to make sure we always met the state standards) a pediatric bag, an als trauma bag, the oxygen bag AND the “drug bag” that was used on almost every call. Bag overkill.

    My first week of rotations we responded to a jumper down and the medics yelled at me for taking the drug bag, o2 bag and monitor, like every other call. I didn’t even realize the one bag was the “trauma bag”. It allowed them to keep their 10 pounds of liter bags and macrodrip sets ready to go and excessive amounts of bleeding control equipment in one place… in fact that’s almost all it had… a duplicate tube kit with lido in it, 3 liter bags with macrosets and start kits made with 14/16/18 ga caths instead of the normal range and no saline locks or flushes… plug in and make cool-aid! Add a bunch of multi-traumas 4x4s abd pads, tape, kerlix and thats all there was in the bag. If i felt that multi liter boluses were the best trauma treatment maybe I’d want to have that bag available. FDNY EMS continues to have both a drug bag and a trauma bag in their ALS units. One of the things I like about having multiple bags is the ability to use the other bag for additional equipment or on extra patients while on scene. If I pull up to a building collapse or MVA I know I need trauma supplies. I’d rather have 2 medium size/weight bags than 1 gigantic one. Even then I’m willing to take a lot of stuff out of the average bag I find around here. I don’t need 30 4x4s, i’d rather use an 8×10 abd pad, i don’t need 20 of them either, I’ve got multi-traumas. I don’t need 20 saline flush syringes, a couple for convenience and then i start drawing from fluid bags… In the bus is different I have plenty of room for a box of them. My goal is to stabilize and transport unless i can provide definitive care on scene. Why must we act like we’re plotting for the zombie apocalypse not a regular sick job or cardiac or MVA.
    -bill

Trackbacks

  1. […] reply to 9-ECHO-1 and to my post A Pediatric Bag Separate From the Adult Gear, was this comment from jim […]

  2. […] A Pediatric Bag Separate From the Adult Gear | Rogue Medic says: Sun, 27 Feb 2011 04:46:22 +0000 at Sun, 27 Feb 2011 04:46:22 +0000 […]

Speak Your Mind