Choosing an Evidence-Based Pediatric Resuscitation Tool You Can Trust
Pediatric resuscitation is one of the highest-risk, highest-stakes moments in clinical care. When a critically ill or injured child arrives, clinicians often have seconds, not minutes, to make decisions that hinge on accurate weight estimation, appropriate equipment selection, and safe medication dosing. For decades, length-based pediatric tools have played an important role in helping teams navigate these moments.
But not all tools are created equal, and accuracy matters.
With the recent FDA Class I recall of a widely used pediatric length-based emergency tape, many clinical teams are asking the same question: What should we use instead? If you’re evaluating a Broselow tape replacement or researching what to use instead of Broselow, it’s critical to choose a solution that improves medication safety, reduces cognitive load, and supports real-world pediatric resuscitation workflows.
What’s Happening with the Broselow Pediatric Emergency Tape
On January 28, 2026, the U.S. Food and Drug Administration posted an ongoing Class I Device Recall for the Broselow Pediatric Emergency Rainbow Tape (2025 Edition, Revision 3). A Class I recall is the most serious category issued by the FDA, indicating a reasonable probability that use of the device could result in serious injury or death.
The recall was initiated by the manufacturer after identification of potentially harmful medication dosing information for certain drugs, including vecuronium, flumazenil, and ketamine, related to the design of the product. The FDA notice directs healthcare facilities to immediately discontinue use of affected tapes and remove them from clinical service.
This action serves as an important reminder. Resuscitation reference tools are not benign. When inaccuracies exist, particularly around medications, the downstream consequences can be significant.
Cognitive Load: Where Traditional Length-Based Tools Help, and Where They Fall Short
Length-based pediatric tools, such as the Broselow Tape, were a meaningful advance when they were introduced in the mid-80’s. They provide a rapid way to estimate a child’s size and select appropriately sized equipment. For airway management, vascular access, and defibrillation decisions, this functionality remains valuable, especially when patient age or weight is unknown.
However, it is important to recognize the limitations of traditional length-based tapes, particularly when it comes to medication administration.
While some tapes list medication doses, they do not account for key variables clinicians must still manage in real time. These include drug concentration, route of administration, bolus versus infusion dosing, or the underlying clinical etiology driving the decision. As a result, clinicians are often left to perform multiple high-risk cognitive steps under stress, selecting the correct vial, converting milligrams to milliliters, adjusting for IV versus IM or intranasal routes, and determining whether the dose is appropriate for the clinical context.
In practice, this means traditional length-based tools often shift cognitive load rather than truly reducing it. They help early, but leave the most error-prone steps, such as medication preparation and administration, dependent on memory, mental math, or secondary references during a resuscitation.
That gap matters. It contributes to dosing delays, calculation errors, and medication administration mistakes, even when a length-based tape is being used correctly.
An Important Clarification: Equipment Carts Still Matter
It is equally important to be clear about what this does not mean.
Equipment carts and color-coded equipment systems remain highly effective for organizing pediatric equipment and supporting rapid, size-appropriate care. We continue to encourage their use. They are familiar, intuitive, and deeply embedded in pediatric emergency workflows, and they should remain so.
The opportunity for improvement is not replacing these systems, but augmenting them where risk remains highest – medication decision-making and administration.
A More Modern Approach to Pediatric Resuscitation
Handtevy is an evidence-based pediatric resuscitation system implemented across more than 3,000 hospitals and EMS agencies. Its content is developed and continuously refined through clinical review, pharmacy oversight, and real-world use in high-acuity environments, with a focus on medication safety, workflow reliability, and reducing cognitive burden during resuscitation.
Modern pediatric emergency care requires more than a single, static reference point. Handtevy was developed with this reality in mind, pairing a familiar length-based framework with real-time clinical support and system-level safeguards. The system includes:
- A length-based tape to estimate pediatric weight and assign standardized color zones. Medications are not printed on the tape.
- Handtevy Mobile, a point-of-care application that delivers weight-based medication dosing, equipment sizing, and procedural guidance.
- Hospital pharmacy oversight, allowing medication content to be reviewed, approved, and governed by the institution.
- Rapid update capability, enabling changes to dosing, concentrations, or algorithms to be pushed automatically to end users without manual replacement of physical tools.
- Offline functionality, ensuring access in elevators, ambulances, disaster scenarios, and areas with limited connectivity.
- No PHI storage, minimizing privacy and security concerns.
- Custom hospital algorithms and clinical pathways embedded directly into the app.
- Built-in checklists and cognitive aids that support team-based resuscitation.
- An award-winning resuscitation metronome that supports high-quality CPR without additional equipment.
This approach recognizes that while length-based estimation remains essential, meaningful error reduction requires addressing the full complexity of pediatric medication administration and team dynamics at the bedside.
Working Within Existing Color-Coded Systems
One common concern when updating pediatric resuscitation tools is disruption. Will crash carts need to be relabeled? Will equipment organization need to change?
Handtevy deliberately aligns with the widely recognized pediatric color-coded system already used in many emergency departments and EMS agencies. By maintaining compatibility with existing color zones, organizations can adopt a modern system without overhauling equipment layouts or retraining teams on an entirely new framework.
This continuity supports safer transitions, clearer communication, and smoother adoption in high-stress environments.
Summary
Healthcare systems have an obligation to ensure that pediatric resuscitation tools are accurate, reliable, and clinically useful. The recent FDA Class I recall of the 2025 Broselow Pediatric Emergency Tape underscores why it is essential to reassess pediatric emergency resources, especially those used during the most critical moments of care.
Length-based tools laid an important foundation and continue to play a vital role. But improving pediatric safety requires moving beyond weight estimation alone.
A modern pediatric resuscitation system should preserve the familiarity clinicians rely on while meaningfully reducing cognitive load where errors are most likely to occur, at the point of medication administration.
FDA Recall Notice:
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRES/res.cfm?id=217896
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