Medication calculation skills of practicing paramedics

To assess the medication calculation skills among a group of practicing paramedics, the types of computations they find most difficult, and the relationship between drug calculation skills and various demographic characteristics.

A demographic survey and a ten-item drug calculation examination were administered to a convenience sample of 109 practicing paramedics representing a cross-section of emergency medical services (EMS) system characteristics in North Carolina. Examinations were scored independently by two graders and error types were assigned to incorrect responses. Examination results were then correlated with demographic and EMS system characteristics.

Overall performance on the drug calculation examination was poor. The mean score was 51.4% (SD 27.4). Intravenous flow rate problems and medication bolus problems were calculated correctly in 68.8% of the cases, followed by non-weight-based medication infusions (33.9%), weight-based medication infusions (32.5%), and percentage-based medication infusions (4.5%). Examination scores were higher among paramedics with college level education, but scores were lower among paramedics with more years of EMS experience. Conceptual errors (i.e., errors in setting up the problem) were more prevalent than mathematical errors, errors in weight conversion, or errors in unit conversion (e.g., grams to milligrams). The participants reported that drug calculations were infrequently performed in daily practice and were rarely a topic of continuing education programs.

Similar to findings among other allied health professions, medication calculation skills were found to be lacking among a group of practicing paramedics. In addition, the paramedics reported infrequent opportunities to perform this skill in the clinical setting and that medication calculations were not a routine part of EMS continuing education programs.