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Updated: Oct 19, 2025

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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Improving Pediatric Drug Safety in Prehospital Emergency Care-10 Years on

Jost Kaufmann, Stefanie Uhl1, Eva Singer2

  • 1Faculty for Health, University Witten/Herdecke, Witten.

Journal of Patient Safety
|September 27, 2021
PubMed

Insights

The Pediatric Emergency Ruler (PaedER) significantly reduced severe medication errors in emergency medical services by 55% over 10 years. This height-based tool, combined with education, improved pediatric drug safety in prehospital care.

Area of Science:

  • Emergency Medicine
  • Pediatric Drug Safety
  • Medical Device Implementation

Background:

  • Life-threatening medication errors pose a significant risk in pediatric emergency care.
  • The Pediatric Emergency Ruler (PaedER) is a height-based tool designed to improve drug dose accuracy.
  • Previous reports indicated PaedER could reduce errors by 90%.

Purpose of the Study:

  • To evaluate the long-term impact of the PaedER tool and associated educational measures on medication errors in a large emergency medical service (EMS).
  • To assess changes in severe drug dosing errors over a 10-year period following the implementation of PaedER in Cologne EMS.

Main Methods:

  • The study analyzed drug administrations from Cologne EMS over two 20-month periods: 2007/08 (pre-implementation) and 2018/19 (post-implementation).
  • Data included doses of fentanyl, midazolam, ketamine, and epinephrine administered via various routes.
  • Severe drug dosing errors were defined as deviations greater than 300% from recommended doses.

Main Results:

  • The overall rate of drug dosing errors decreased from 22.0% to 9.9% (55% relative risk reduction).
  • Severe dosing errors for epinephrine were reduced by 78%.
  • Documentation of patient weight significantly increased from 3.2% to 30.5%.

Conclusions:

  • The combined implementation of the PaedER tool and educational initiatives effectively reduced severe medication errors in a prehospital setting.
  • These findings support the widespread adoption of PaedER and similar strategies to enhance pediatric drug safety in emergency care.
Abstract

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