The Road to 97%
The Road to 97%
How One EMS Region Rewrote What Is Possible in EMS Medication Safety
Pediatric medication errors in EMS have been a longstanding patient safety problem, with published error rates ranging from 36 to 49% across systems. For midazolam in pediatric seizure, one of the most time-sensitive medications a paramedic will ever push, dosing accuracy has historically hovered around two-thirds correct. Behind every one of those errors is a parent, a child, and a clinician who walked away knowing something went wrong. This white paper documents how Monroe-Livingston Regional EMS, a multi-agency system in upstate New York serving 814,000 residents, moved pediatric medication dosing accuracy from a baseline of 79% to a sustained 97%, exceeding their 95% aim and reaching a level of reliability the EMS community has not seen at this scale. The intervention paired the Handtevy platform with disciplined quality improvement, human-centered design, and a culture that treats failure as a teacher. The lesson is not that a tool fixed the problem. The lesson is what it took to make the tool work.
Education alone was insufficient to mitigate this error. System redesign was required.
What This Paper Covers
The Baseline Problem
The paper examines why pediatric dosing sits at the intersection of weight-based math, multiple concentrations, multiple routes, and time pressure.
The Fold Error Argument
Reducing variability around the correct dose, not just hitting a threshold, became the operational definition of success.
The Iterative Journey to 97%
Implementation alone produced an initial lift from 79 to 91%. But 91 is not 95, and 95 was the goal.
The Midazolam Protocol Change
The paper walks through how education alone did not fix it, and what tool redesign finally did.
What a Colorblind Paramedic Found
A story from simulation training that the team would not have caught any other way.
Why the Measurement Was Pediatric
Pediatric dosing is the hardest case in EMS. The pediatric numbers are the stress test. The adult use is the everyday job.
The Three Things That Sustained Performance Required
Most EMS systems chase the same outcome by changing the protocol or running a one-time training. The Monroe-Livingston experience shows that approach produces a few points of improvement and then plateaus.
The Road to 97%
How One EMS Region Rewrote What Is Possible in EMS Medication Safety