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Emergency Care for Children: Growing Pains
next. Because the technology relied on human intelligence for programming, errors naturally occurred. In a neonatal ICU, for example, an infusion rate was programmed to 304 ml/hr when the physician intended the rate to be 3.4 ml/hr. In many cases, critical errors were made because a single wrong button was pressed (Reves, 2003).
Advances in infusion technology led to the introduction of “smart pumps,” which are widely used today. Smart pumps utilize software that checks programmed doses. The software contains information on drugs, their usual concentrations, dosing units, and dosing limits. When the practitioner uses the pump, he or she programs it for use in a designated area (e.g., adult ICU, neonatal ICU), and the pump is automatically configured for use on adults or children. Additional safeguards are also built into the pumps, for example, alerting the user if the dosage exceeds the hospital’s established limit and not allowing the user to base the dose on the patient’s weight if the drug is not dosed on that basis (Reves, 2003).
A market for pediatric technologies, equipment, and supplies must be stimulated so that products will be designed initially to meet the needs of pediatric patients, instead of being adapted from products originally designed and intended for use with adult patients. The market for pediatric-designed products has not been well developed in part because providers have not been compelled to purchase pediatric-specific products. To stimulate demand for such products, emergency providers should be made aware of the potential shortcomings of products designed for adults and adapted for children. To advance this effort, the committee recommends that federal agencies and private industry fund research on pediatric-specific technologies andequipment for use by emergency and trauma care personnel (5.4).
This is not the first recommendation of its kind. The 2005 Institute of Medicine (IOM) report Safe Medical Devices for Children emphasized the need for the FDA, the National Institutes of Health (NIH), and AHRQ to define a research agenda and priorities for evaluation of the short- and long-term safety and effectiveness of medical devices for children (IOM, 2005). The report also called for the FDA to work with industry and others to focus more attention on adverse events involving the use of medical devices for children and to update product labeling promptly to reflect safety-related findings. Emergency providers should be able to take comfort in knowing that the equipment they are using on pediatric patients is safe and effective. Development and testing of new products are needed to give providers this assurance.
Federal agencies and private industry also need to take a careful look at the technologies already in place and available for use with infants, children, and adolescents. For a number of devices and technologies being used on pediatric patients, it is unclear whether they ultimately do children more good than harm. One example is the growing use of pediatric computed tomog-