Handtevy

What does 97% correct pediatric medication dosing actually look like?

It looks like a 12-agency EMS system in New York that refused to stop asking hard questions.

Before implementing Handtevy, their dosing accuracy was 79%. Midazolam for pediatric seizures? Correct only 65% of the time. These weren't careless providers. These were dedicated paramedics and EMTs working in a system that hadn't yet given them every advantage possible.

So they changed the system.

They didn't just roll out new technology and move on. They built a culture of continuous improvement:
✅ Monthly case review to understand exactly where and why each error occurred
✅ Distinguishing between "no access to the tool," "had access but didn't use it," and "used it but the display created confusion"
✅ Acting on each failure category differently, with targeted solutions

When midazolam dosing changed from 0.1 to 0.2 mg/kg IM/IN and errors crept back in, they didn't blame providers or pile on more training. They looked at the interface itself, redesigned how the preferred route was displayed, and watched accuracy recover.

That's what rigorous, humble, data-driven EMS medicine looks like.

The result? 97% correct pediatric medication dosing, the highest ever reported in peer-reviewed EMS literature. For a 9-year-old in the back of an ambulance at 2am, that difference is everything.

The question worth asking in your own system isn't "are we doing well enough?" It's "how would we even know, and what would we do about it?"

That's the standard these providers set. And it's one any system can pursue.

Read the full study:https://media.handtevy.com/website/Improving-Pediatric-Medication-Safety-Through-Implementation-of-Evidence-Based-Guidelines.pdf

A great week in our hometown of Fort Lauderdale at Gathering of Eagles/First There, First Care! 🔥

We loved showing attendees how Handtevy brings protocols, analytics, reporting, and operational insights together in one place. The response was incredible, and it sparked some great conversations about gaining greater visibility into clinical and operational performance.

Along the way, we caught up with current customers, met new faces, and hosted a Handtevy Instructor Course alongside so many passionate EMS professionals.

Thank you to everyone who stopped by, attended the course, and shared part of your week with us. We're grateful to be part of such a dedicated community.

See you at the next one. 🤝

Every EMS crew has given nitro hundreds of times.

We place a 0.4 mg tab under the tongue. Patient says "ahhh, better." We feel good. We helped.
But here's what a study of 70,890 chest pain patients across 2,119 EMS agencies just found:

Zero difference in preventing bad outcomes.
→ Same rate of CPR
→ Same rate of defibrillation
→ Same rate of cardioversion
→ Same rate of antiarrhythmic drugs
→ Same rate of transcutaneous pacing

Nitro group: 0.17% bad outcomes.
No-nitro group: 0.18%. Statistically identical.

The researchers used clone-censor weighting, a sophisticated method specifically designed to eliminate confounding and immortal time bias. This wasn't a simple comparison. They worked hard to find an effect. They didn't find one.

Even in suspected STEMI patients, where reducing cardiac workload should matter most, the signal didn't reach significance.

Worth noting: the point estimates in STEMI patients trended toward benefit, and the authors plan to study that subgroup further.

That's an honest finding, not a dismissal.

So what does this mean practically?

Nitro still relieves pain. That matters. But for years, our culture has assumed it prevents arrhythmias and saves lives in the back of the truck.

This data doesn't support that assumption.

It also raises a harder question: why do we reach for nitro before considering other analgesics?
Pain management is the goal. The tool should match the evidence.

The authors are transparent about the limitations. The composite outcome was rare, which limits precision. Residual confounding is possible.

This is one study, not a closed case.

But it's a well-designed study asking a question that needed to be asked. And the answer deserves an honest conversation.

Have you ever had a chest pain patient deteriorate right after nitro? What did you think caused it?

Read the full study:https://media.handtevy.com/website/A-Target-Trial-Emulation-of-Prehospital-Sublingual-Nitroglycerin-Administration-for-Suspected-Acute-Coronary-Syndrome.pdf

25 𝐲𝐞𝐚𝐫𝐬 𝐨𝐟 𝐞𝐯𝐢𝐝𝐞𝐧𝐜𝐞. 𝐈𝐭'𝐬 𝐭𝐢𝐦𝐞 𝐭𝐨 𝐫𝐞𝐭𝐡𝐢𝐧𝐤 𝐬𝐩𝐢𝐧𝐚𝐥 𝐢𝐦𝐦𝐨𝐛𝐢𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐄𝐌𝐒.

Since Hauswald's pivotal 1998 Malaysian study, we've had a quarter century of data pointing in the same direction. The evidence against routine spinal immobilization is substantial:

→ No demonstrable benefit in any study
→ Consistent evidence of harm: respiratory compromise, pressure ulcers, increased pain
→ Zero cases where withholding immobilization led to legal liability
→ Multiple cases where applying immobilization caused legal problems

The Wilderness Medical Society's 2024 guidelines, developed by a multidisciplinary team including orthopedic surgeons and EMS physicians, recommend against routine immobilization for suspected spinal injury.

So where does that leave us practically?

Personally, I'm not advocating for removing collars entirely. I'm advocating for using them selectively, based on clinical judgment. A stepwise approach, where paramedics can clinically clear the c-spine in the field, can eliminate the collar in roughly 80% of cases that would have received one under a reflexive protocol. The collar remains available for patients where clearing isn't possible.

The honest reality: the medicolegal concern keeping many of us from changing practice is, per the authors, a shibboleth grounded more in culture than evidence.

EMS culture adds interventions easily. Removing them, even with overwhelming evidence, is far harder.

The authors ask: "How many patients need to be harmed?"

What does your service's spinal management protocol look like today? This is a conversation all of us will benefit from, including our patients.

-PA

Read the full study:https://media.handtevy.com/website/Out-of-Hospital-Management-of-Suspected-Spinal-Cord-Injuries-How-Much-Evidence-Does-it-Take-to-Change-Practice-.pdf

This month's 𝗧𝗲𝗮𝗺 𝗠𝗲𝗺𝗯𝗲𝗿 𝗦𝗽𝗼𝘁𝗹𝗶𝗴𝗵𝘁 is here! 🌟 We're showing off Odalys Jordan this month. She quietly keeps everything moving—taking on expanded leadership, driving key initiatives, and launching projects that will shape how our teams work for years to come. From customer escalations to cross-functional strategy, she delivers every time.

𝗪𝗵𝘆 𝗦𝗵𝗲 𝗦𝘁𝗮𝗻𝗱𝘀 𝗢𝘂𝘁 💙
Odalys exemplifies accountability, teamwork, and excellence—leading engineering process improvements, championing automation, and playing a critical role in bringing the Platform Analytics Dashboard to life. She balances priorities effortlessly, supports teammates across the company, and approaches every challenge with integrity and a whatever-it-takes attitude.

𝗙𝘂𝗻 𝗙𝗮𝗰𝘁!
When she's not moving projects forward, Odalys loves traveling and making memories with her family—always ready for the next adventure, likely with a French cruller in hand! ✈️

One week later and we're still thinking about this room, already asking: 𝙬𝙝𝙚𝙣'𝙨 𝙩𝙝𝙚 𝙣𝙚𝙭𝙩 𝙤𝙣𝙚? 🤩

The inaugural 𝗛𝗮𝗻𝗱𝘁𝗲𝘃𝘆 𝗘𝗠𝗦 𝗜𝗻𝗻𝗼𝘃𝗮𝘁𝗶𝗼𝗻 𝗦𝘆𝗺𝗽𝗼𝘀𝗶𝘂𝗺: 𝗭𝗲𝗿𝗼 𝗠𝗮𝗿𝗴𝗶𝗻 brought together EMS leaders, clinicians, and innovators for a day of real, unfiltered conversation and the energy in that room was unmatched. Packed room, hands raised, questions flying, and a lot of laughs in between.

🌟 Thank you to every speaker who brought their expertise and to every person in that audience who kept the energy alive.

Because in EMS, there's zero margin for error.
This is only the beginning. 💪

Were you there? We want to hear your favorite part! Share it in the comments below.

Handtevy has arrived at First There, First Care/Gathering of Eagles 2026!! 🚨⚡️

🔥 Stop by Booth #620 and see how one dashboard gives you total control over your entire clinical ecosystem—protocols, pharmacology, and everything your clinicians see at the point of care.

Interested in becoming a certified Handtevy Instructor? Join us from 8AM-5PM. Last minute spots are still available for just $299!

👉 Register here >> https://courses.handtevy.com/event-directory/handtevy-instructor-course-26/