Literature Review: Paramedic Broselow Weights

Literature Review: Paramedic Broselow Weights

Heyming T, Bosson N, Kurobe A, et al. Accuracy of paramedic Broselow tape use in the prehospital setting. Prehosp Emerg Care 2012 Jul–Sep; 16(3): 374–80.


The Broselow tape is widely used to rapidly estimate weight and facilitate proper medication dosing in pediatric patients. [Authors] aimed to determine the accuracy of prehospital use of the Broselow tape. Methods—[Authors] prospectively enrolled a consecutive sample of pediatric patients transported to the emergency department (ED) at Harbor-UCLA Medical Center from February 2008 to January 2009. Eligible subjects arrived via ambulance and were less than 145 cm tall, the upper limit of height for Broselow measurements. Subjects were excluded if they had a medical condition preventing proper measurement (e.g., contractures). Per Los Angeles County protocol, paramedics obtained a Broselow weight on all pediatric patients. The paramedic Broselow weight was compared with the ED Broselow weight and the ED scale weight, which was obtained unless mobilization was contraindicated. Accuracy was determined by assessing Bland-Altman plots and the Pearson correlation coefficient. As part of a sensitivity analysis, multiple imputation was used to account for missing data.

Results—There were 572 subjects enrolled. The median age was 24 months; 55% of the subjects were male. The weighted Cohen’s kappa assessing agreement between the paramedic and ED Broselow colors was 0.74. The median difference between the paramedic Broselow weight and the scale weight was -0.10 kg. The accuracy of the paramedic Broselow weight when compared with the ED scale weight and the ED Broselow weight as defined by Pearson’s correlation coefficient was 0.92 and 0.97, respectively. Conclusion—Paramedic Broselow weight correlates well with scale weight and ED Broselow weight. Paramedics can use the Broselow tape to accurately determine weight for pediatric patients in the prehospital setting.


In the December 2011 issue I reviewed a study that showed dosing errors in pediatric patients were common: 35% of administered medication dosages were more than 20% too high or too low. Part of the problem is that pediatric resuscitation a high-risk/low-frequency event, and, with the emotional component of treating a sick/injured kid, is a stressful and challenging encounter. The solution must be simple and universal: an approach that ideally is used consistently in every case. The authors argue that the Broselow tape can be part of such an approach.

The noise around this subject has only created confusion and indecision. Does the Broselow tape work for all ethnic groups? For boys and girls? How about the (now more common) obese patients? How good is the mom’s estimate of the weight? The fact is that other weight-estimation methods (age-based calculations, parent estimation, provider estimation), although possibly somewhat useful in the office or clinic setting, are either less accurate or less practical for EMS. What if you don’t know a child’s age? If a parent is not there? If a parent is altered and can’t tell you (or gives you an incorrect) age/weight?

The Broselow tape has been around for more than 25 years and validated in multiple clinical trials. It is simple, light, durable and universal. These authors have shown it is highly accurate for EMS patients, regardless of size or severity of illness/injury. They also point out that most resuscitation medications given in EMS are best dosed on lean body mass (ideal weight, not actual weight), so for obese patients the height may be an even better predictor of most effective dose than weight.

If one (and only one) method were used to determine the size of devices and dose of medications for all pediatric patients every time, the error rate would be expected to decrease. EMS systems should consider standardizing on one weight-estimation method, and the Broselow tape may be the most appropriate tool.

Angelo Salvucci, Jr., MD, FACEP, is medical director for the Santa Barbara County and Ventura County (CA) EMS agencies and a member of the EMS World editorial advisory board.

The drones are used to improve scene management by assessing areas that are difficult or dangerous for personnel to reach.
The state's Department of Health has established an agreement for UNC and NCBP to collaborate on providing public health data to NEMSIS to better prepare EMS for national emergencies.
FBI, first responders, and the American Red Cross worked around the clock to find the four missing men until Cosmo DiNardo confessed to killing them, leading police to their burial ground.
Scenes function better when EMS can work collaboratively

Summer means mass gatherings, like festivals, sporting events and other popular crowd draws, and those bring their own unique sets of EMS challenges.

Dispatch centers will lose funds entirely if the bill aiming to increase phone surcharges to help support and improve the 9-1-1 call centers is vetoed by the governor.

Ambulance service in Tennessee's Decatur County is in danger of interruption because EMS is out of money, according to Mayor Mike Creasy. 

Leaders from three recent responses debated some pressing questions 

As the tragedies of terrorist attacks continue to unfold, first responders everywhere know one day the call may come to them. Whether it be in a Manchester arena, the London Parliament or outside a Stockholm department store, citizens expect a prepared and competent response.  

In the final days of August 2016, the citizens of Pasco County, Fla., were preparing for Hurricane Hermine, the first to make landfall in Florida in over 10 years.
Ever since the sinking of the Titanic in 1912, the world’s maritime nations have created and updated a framework to maintain minimum safety standards for merchant and passenger vessels. For the United States this responsibility falls to the U.S. Coast Guard.
Police, fire and EMS agencies will partake in an exercise involving an active shooter at a local elementary school.
Nine emergency agencies, including a crisis response team, trained for a drill that included a hostage situation and explosion.
EMS, fire and police agencies participated in an active shooter training exercise in light of the increasingly frequent shooting incidents across the country.
New dangers have arisen from the influx of fentanyl into the drug market.
Greg Gibson of the DHS' Emergency Services Sector discusses current threats facing first responders.