- Why do I need the Sandell Tape™ ?
- How does it work?
- Will it work in the rain?
- Does it work with obese children?
- How does it fit in with my services protocols?
- Are the colours linked to the Broselow Tape?
- How do you use it if the child can't be laid down?
- What is the Smart Tape™?
- How do the Smart Tape™ and the Sandell Tape™ work together?
- Where does the data for the Sandell Tape™ come from?
Why do I need the Sandell Tape™ ?
10% of all emergency calls involve children. However, children often evoke strong emotional responses in rescuers, leading to high stress and increased anxiety. Paediatric drug dosages can be difficult to calculate especially when the child's age is unknown.
"There should be uniformity in the provision of drugs and equipment suitable for children across all ambulance Trusts." ¹
"...considerable improvement will be necessary from the current situation." ²
The Sandell Tape™ has been specifically designed to work in low light or poor visibility and uses the most up to date JRCALC Guidelines
The Sandell Tape™ reduces the stress and allows for accurate dosages to be quickly identified.
How does it work?
When the child's weight or age is known, the responder can simply use the Sandell Tape™ as a "look-up" chart and use the box on the bottom edge of the chart that corresponds to the appropriate age or weight.
If the child's age or weight is not known, align head with top of chart (red line), and measure against outstretched leg, locating the correct drug/equipment in the box in which the child's feet lie - About Sandell Tape™.
Will it work in the rain?
The Sandell Tape™ is completely water proof and made out of a tough tear resistant material.
Does it work with obese children?
The Sandell Tape™ is designed as a reference chart and has been constructed using approved British reference data corresponding to the average child's weight for that age range.
For overweight children, if the child's weight is known, this can be used to select the appropriate intervention using the weights described along the bottom of the chart. For example if a 5-year old was known to weigh 20 kg, then doses and equipment from the 6-year old box (weight up to 20.6 kg) might be more appropriate.
Where the child's weight is not known, it may be appropriate for responders to select the next box for larger children although this is solely at the responders discretion and as such the manufacturer can accept no responsibility.
How does it fit in with my services protocols?
All UK Ambulance service protocols are based around the JRCALC guidelines, which the Sandell Tape™ encompasses. If there are local variations then you should consult with your clinical governance manager or other relevant authorities.
"All ambulance services should comply with the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines for clinical practice." ³
The Sandell Tape™ reflects current "best practice" evidence based paediatric emergency care.
Are the colours linked to the Broselow Tape?
No.
There are two sets of colours on the Sandell Tape™ . One is the universal drug colours, and the second simply separates the tape along ABCD lines for clarity.
How do you use it if the child can't be laid down?
The tape is flexible to be molded around the child when they are standing up, strapped in a car seat or trapped in an awkward position.
What is the Smart Tape™?
The Smart Tape™ is a paediatric measuring tape for determining the triage category of a child at a multiple casualty incident.
It is the only evidence based method of triage for children (4*) and is taught on Pre-Hospital Paediatric Life Support (PHPLS).
For further details of Paediatric Triage please refer to ; Pre-Hospital Paediatric Life Support, the practical approach 2nd ed. Published by BMJ Books.
How do the Smart Tape™ and the Sandell Tape™ work together?
In a triage situation the Smart Tape™ would be used to identify the most seriously injured children. Once the incident moved into the treatment phase the Sandell Tape™ would be used to calculate the appropriate dosage of drugs and correct size of equipment. Both tapes have a distinct role.
Where does the data for the Sandell Tape™ come from?
Bodily measurements
Data measurements used on the SandellTape™ were obtained from UK Cross-sectional Reference data for Boys and Girls 1, which represent the ages, weights and heights of the UK’s child population, when measured in 1996. For each given age, the 50th percentile weight for boys and girls was recorded and averaged, and this weight was then used to calculate the appropriate drug dosage for that age.
e.g. dose of Hydrocortisone (4mg/kg) for a 5-year-old child with anaphylaxis...
- average 5-year-old boy weighs 18.633 kg,
- average 5-year-old girl weighs 18.299 kg, hence...
- average 5-year-old child weighs 18.47 kg (1.)
therefore, the required dose is calculated as 74kg.
Other charts and guidelines use the child’s length measurement to estimate their weight. This effectively requires the injured child to be moved to a flat surface, in order to measure its supine length. The usefulness of such length-based assessments can however often be limited in pre-hospital practice. Injured children are typically anxious, agitated, combative and uncooperative, especially if not accompanied by an adult carer. There may also be physical or environmental hazards which would limit such measurements e.g. the trapped child or the child with neck injuries, where movement may be hazardous.
The Sandell Tape™ overcomes these difficulties, by using the UK Reference Data 1 to establish age-based estimates, allowing the child’s age (rather than supine length) to be used as the reference. This reflects "real-life" clinical practice - often the child’s first name and age is all that is known at the scene of an incident - information (age) which the SandellTape™ uses to estimate the child’s weight and as a result guide the appropriate intervention..
e.g. in the UK,
- average 12-month-old boy weighs 10.104kg,
- average 12-month-old girl weighs 9.4596kg, hence...
- average 12-month-old child weighs 9.78kg.
There will however be rare circumstances where the child’s age is not known e.g. an unsupervised child found to be unconscious, and the Tape also makes provision for this. The child can be laid flat against the Tape, and supine length measurements made to provide a length-based estimate of weight, which again utilises the 1996 UK reference data. Lengths have been ascribed to each individual age group by averaging the heights of the 50th centile Boy and Girl (1), providing an average length for each Boy-Girl age, from birth to 11 years.
Age ranges
The SandellTape™ was designed for the resuscitation/treatment of all prepubertal children from "Newborn" upwards. Although JRCALC’s Guidelines (2) do cover Neonatal Resuscitation, this is beyond the scope and realms of the Tape and were not included. Similarly, at the other extreme, it was not designed for the post-pubertal adolescent – where appropriate such individuals should be treated according to "adult" criteria. [Beyond puberty, male and female bodily proportions become divergent, and as a result, a simple "one-size-fits-all" approach becomes unsafe and of little value (3).]
1 Child Growth Foundation UK cross-sectional reference data Girls and Boys Four-in-One Growths Charts, 1996/1. (Charity Reg. No 274325). 2 Mayfield Avenue, London W4 1PW.
2 UK Ambulance Service Clinical Practice Guidelines (2006), Joint Royal Colleges Ambulance Liaison Committee (JRCALC). October 2006.
3 Paediatric life support. An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation. Resuscitation. 2005 Dec 67(3).
1, 2, 3 - Page 23, Services for Children in Emergency Departments, Published by the Royal College of Paediatrics and Child Health. - http://www.rcpch.ac.uk/Health-Services/Emergency-Care
4 - Paediatric Triage Tape - Journal of Prehospital & Immediate Care 1998 - http://www.tsgassociates.co.uk/downloads/journalofprehospitalimmediatecare.pdf
PROMOTING CALM, IMPROVING CARE
TSG Associates
© Copyright TSG Associates LLP 2004 - 2012. All rights Reserved.