Why was it a bad system? Because there was no system! In response to this problem, I teamed up with Bob Luten, one of the early PEDS EM leaders who was part of the original PALS subcommittee. The system – estimating the weight, weight-based dosing, mgs per/kg, micrograms per kg, conversions to mLs, dilutions, equipment sizes, ventilator settings, missing critical equipment, fragile patients and stress – was a formula for disaster. The process of creating that first Broselow Tape opened my eyes to how a bad system can confound even the most dedicated healthcare professionals. The Tape began to take off, and the rest is history. It was a universal problem, and the Tape provided a much-needed solution. What I quickly learned was that it wasn’t just me who was nervous about treating an acutely ill or injured child. (What I wouldn’t give to still have that original leather prototype.) Then I was off to Hartford. I had him cut me a strip of leather and my wife, Millie, wrote the lines and doses on the leather tape with a pen. I knew I needed a better prototype, so I reached out to yet another neighbor, one who made saddles for a living. I called him up and told him about my “study.” He was interested and invited me to present it to his academic group. About that time I read about a new course being put together called “PALS” being headed up by Leon Chemeides, a pediatric cardiologist from Hartford Connecticut. About 6 months later he called me up and informed me that the Tape performed quite well. I asked the head of the course if he was willing to do the evaluation and he suggested he take it on for a class project. I had no clue how to crunch the numbers, but in Hickory, NC we had Lenoir Rhyne, a college which taught a course in statistics. The prototype was sewn by hand by Bob Luten’s mother.īy that time I was pretty familiar with the local medical community and so I asked three different pediatric offices if they would be willing to measure their children with the Tape – which only had numbers on each zone – weigh the child, and then give me the raw data. This photo, which appeared in the Charlotte Observer in the mid 1990s, demonstrates a roll-up organizer containing appropriate color coded equipment. He agreed to turn the tables into a linear scale that statistically put the weights into even KG zones. I also had a neighbor who was a CPA who had access to a computer. I had an old copy of Nelson’s Pediatrics which had a height/weight table in the back. I am sure I slept through the parts that had to do with control groups and statistics and yet there I was in rural North Carolina, attempting to conduct a research study of my own. I sat in the back row of every lecture in medical school and hoped they didn’t ask me any questions (we were all paranoid in those days). You see, I was the exact opposite of an academic. But he didn’t.Īt that time it hit me that I needed to do a “study,” which automatically made me chuckle. If he’d rejected the notion, called it stupid, the Tape may have died right there. Farley, a surgeon at the time, what he thought about pulling out a carpenter’s tape that had all of the doses on it and keeping it in your pocket. The first thing I did after seizing upon the idea was ask Dr. I woke up one morning and realized that “The Tape” was what I needed. The simple, honest answer is that it was born out of my own anxiety in learning to care for sick children. Over the years people have asked me about that initial spark that led to the idea that has become so ubiquitous. I needed a more objective system to lean on, and so the idea of the Tape was born. It was difficult for me to control my thoughts and emotions when a child’s life was at stake and having the family in the room kept me from retreating into my problem solving mode their anxiety was contagious. The transition was rather quick as far as adult emergencies was concerned, but dealing with a critically ill child with the mother in the room made me long for the days of the scheduled H and P in the comfort of my office. To my surprise, I enjoyed it so much that I became an ER Doc. Planning to build an office there I supported my family by moonlighting in the ED. In the early 1980s I closed my family medicine practice in Michigan and we moved to North Carolina. The problem was that the circumstances were not “difficult ” they were impossible. I am certain that an outside observer would have said that our ER team “did the best we could” under difficult circumstances. All the preparation, planning, memorization and practice in the world cannot fully prepare you for that moment. The look on her face stuns me and in less than an instant her panic, fears and raw emotions become my own. A mother bursts into the ED waiting room where I happen to be, sees my white coat and hands me a non-breathing infant. How “The Tape” came to be, and what its invention says about emergency medicine
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