The Evolution of Excellence in Pediatric Emergency Care—Part 2: The Handtevy System—The Next Generation

This is the second in a three-part series.

Caring for sick kids—especially really, really sick kids—is stressful, and as our stress levels increase, so does our likelihood of error. Lack of regular practice with these types of emergencies can make matters worse, and if we add mathematical calculations to the equation, the challenge is compounded.

In the first part of this three-part article series, we looked at the development and use of the Broselow tape, as well as a couple of pocket-size memory aids that can help us sort out the complexity of pediatric emergencies. In this installment we’ll explore a newer alternative: the Handtevy pediatric resuscitation system.

The EMS world was introduced to the Handtevy system in 2010. Peter Antevy, MD, is a practicing pediatric emergency medicine physician and EMS medical director in Florida. He created a hybrid system that utilizes both age and length. Since the age of the child is often known, Antevy recommends using this information first. To simplify matters and make some first-line pediatric code information immediately available, he developed the Handtevy Badge Buddy, which can be clipped onto an ID badge, and corresponding wall-mountable posters. These items use age categories of 1, 3, 5, 7, and 9 and are color-coded to coordinate with other Handtevy system products.

Even if the age is not known or the child appears smaller or larger than their stated age, the Handtevy tape is a great tool for pediatric emergencies. Providers can begin to plan their treatment algorithm prior to arrival on scene, as they do for adults. Whether the provider uses age or length, customized medication dosing is easily found on printed guides or electronically with a mobile or desktop application. There is a customization feature on the electronic version that allows all dosing information to match the agency or hospital formulary,  reducing the chance for error.

Key points to remember when utilizing the Handtevy tape:

• Always remeasure and confirm the correct color and/or age when the child arrives at the ER, just to be safe; 
• The Handtevy system uses the same color scheme and lengths as the Broselow system. That’s important and will lead to fewer mistakes when EMS and the hospital ED are using different systems; 
• Color zones range from 2–60 kg. The name of the color is printed on the bottom for color-blind professionals. The Handtevy tape is slightly longer to account for taller children with weights up to 60 kg; 
• The Handtevy system allows the use of age or length. When using the Handtevy tape, the child’s heels will land on a color and age category, which corresponds to weights, medications, and equipment;
• Just like the Broselow-Luten system, measure head to heels, not to toes. As a reminder of where to measure from, there’s a big red arrow at one end and, in very large letters, instructions stating: Start here at the top of the child’s head; measure to the heel;
• By the “red to the head” arrow, there is a chart showing age, color, and ideal body weight.

Unlike the Broselow tape, the Handtevy tape has no medical information listed on it. Antevy recommends the only time the tape should be used is if the age is not known or the child appears smaller or larger than their stated age. Otherwise he recommends using the customized guidebooks or mobile app to find the age-appropriate medical information. 

As Antevy is an EMS medical director, one of his goals is for the paramedics in his system to prepare before arrival on scene. Facing a child in full arrest is not the time to try to figure out calculations. So if medics are dispatched for a 3-year-old, even before their arrival they can simply use their Handtevy guide or electronic app to access the needed information. In just a moment, and before arrival on the scene, they can find that a 3-year-old should need a 4.0–5.0 ETT, that the child should ideally weigh approximately 15 kg, and that the first dose of epinephrine IV is 1.5 mL.

And if the local emergency department also uses the Handtevy system, getting the age of an incoming pediatric patient can allow the ED staff time to grab their pediatric crash cart, open the correspondingly labeled drawer, and have appropriate medication doses calculated and tubes waiting when the child hits the door.

In the final portion of this series covering tips and tools for dealing with pediatric emergencies, we’ll look at what the future holds and how we already have incredible new resources at our fingertips.  

Scott DeBoer, RN, MSN, CPEN, CEN, CCRN, CFRN, EMT-P, is an international pediatric seminar leader and nurse consultant with more than 25 years of nursing experience. He retired from flight nursing in 2015 following more than 20 years with the University of Chicago Hospital UCAN flight team. He is the founder and primary seminar leader for Pedi-Ed-Trics Emergency Medical Solutions. 

Emily Dawson, MD, is a pediatric emergency medicine and critical care attending physician at Advocate Children’s Hospital, Oak Lawn, Ill.

Lisa DeBoer, CET, NREMT, PI, is president and cofounder of Pedi-Ed-Trics Emergency Medical Solutions. 

Julie Bacon, MSN-HCSM, RNC-LRN, NE-BC, CPN, CPEN, C-NPT, has more than 25 years of experience in emergency transport medicine, with expertise in pediatric and neonatal transport and critical care. She is program manager and chief flight nurse for Johns Hopkins All Children’s Life Line, St. Petersburg, Fla.

Michael Seaver, RN, BA, is a healthcare informatics consultant based in Chicago.