Back in the mid-1980s, when Jim Broselow, MD, an ER physician from North Carolina, and Bob Luten, MD, a pediatric ER doctor
from Florida, came up with a simpler way to deal with the stressors associated with caring for critical children in the emergency
department, they had no idea they would literally be changing the world of caring for sick kids forever.
Correctly measuring a child on their Broselow-Luten color-coding tape (commonly referred to as the Broselow tape) allows us to
quickly obtain various emergency tube sizes and medication doses for a patient’s age and weight. Since the tape came off patent,
others have utilized the same color zones to create their own systems. With few exceptions, these color-coded systems are built
from those original Broselow colors. In order, they are grey, pink, red, purple, yellow, white, blue, orange, and green. Each
color corresponds to an appropriate tube size, fluid amount, drug dose, etc.
A challenge for many is identifying the correct color zone for the child. If you think that sounds crazy because it’s easy, let me assure
you otherwise. I’ve seen the tape used incorrectly for years during practice sessions even when people aren’t stressed—it can and
does happen all the time.
Practice Makes Proficient
When your tape is locked in a peds crash cart drawer or zip-tied in a pedi bag, looking at it, practicing with it, or even just touching it
can be all but impossible. Think of the last time you took the tape out and really looked at it. The only way to truly get good at
something is to do it over and over. Repetition is the key to mastery—so if you can’t even look at your tape because it’s locked up,
how will you know where to find critical information on it when you’re stressed?
The tape is meant to be used from the top of the child’s head. Remember, red goes to the head—that’s where measure from this
end is printed on the red arrow. Then measure to the heel of their extended foot (not the toes). On the Broselow tape this technique
gives you the color zone and approximate body weight of the child.
Now, this is the part where people freak out. “What about obese kids?! They clearly weigh more than the tape or app says!” Whether
you’re using the Broselow tape, Handtevy system, or one of the other rainbow-colored tapes out there, it’s time to let this question
go. The idea behind all the color-coded toys is simply to get you into the ballpark and hopefully keep you from unacceptable errors.
For more than 20 years my husband, Scott DeBoer, RN, MSN, EMT-P, and our team have been trying to teach better ways to care
for kids. In our experience a seemingly universal axiom is, “The smaller the kid, the higher the stress”—and times of higher stress
are when avoidable errors can occur. Despite our efforts and all the amazing educators we’ve met over the years trying to improve
the world of pediatric emergency care, badness still abounds. Well-meaning practitioners are still committing errors despite one very
simple and easily implemented solution: We don’t practice enough with the tools in our pediatric toolbox!
If any piece of equipment requires concentration to use and you don’t touch it for a year or more, it’s darn near impossible to be
good with that equipment, regardless of how good your memory is. When we encounter a child in full arrest, everyone is naturally
and appropriately stressed. Then someone grabs the color-coded tape and proceeds to measure the child with the wrong end up!
Suddenly a child who should have measured in the pink zone is now in the white zone, and no one catches it until the pediatric ICU
has to replace the giant endotracheal tube.
This sad mistake has caused far too many children to needlessly require surgeries for damage to their tracheas and is a not-
uncommon source of calls to our office from attorneys looking for pediatric malpractice experts. The other common malpractice call
we receive involves the miscalculation of drug doses because healthcare professionals assume they will remember how to properly
use the tape.
It all comes down to practice, practice, practice. If you knew it would be your child or grandchild on the next critical pediatric call, how
much would you practice then? Would you practice daily? How about just weekly for a few minutes to keep your skills sharp?
Perhaps it’s time we give our tiny 1% (the national average EMS rate of critical peds calls) the training time they deserve instead of
counting on someone more experienced being on shift to save the day.
An Apt Mnemonic
Want a simple way to remember the Broselow and Handtevy color sequences so you don’t accidently measure from the wrong side
of the tape? Here’s a mnemonic: Give pediatric resuscitations priority—you will be overwhelmingly grateful. These first letters
correspond to those of the colors.
Conclusion
We hope critical peds calls will never happen on our shift. We pray someone more experienced will save the day. We hope a
supervisor or chase vehicle will pull up to take over. But what happens if no one shows up, and you have a brand-new partner on
their first day—then what? All eyes are on you!
Regardless of whether you have a color-coded tape, a Pedi-Wheel in your pocket, or an app on your phone, please take a few extra
minutes at the start of your shift and open those tapes and apps to prepare. Let’s give our critical kids every possible chance to
make it home to chase rainbows, and not send them somewhere over the rainbow for eternity!
The author thanks Scott DeBoer, RN, MSN, EMT-P, for his assistance with this article.
Sidebar: Additional Memory Aids
Here are some additional ways to help remember the ages that correspond to the colors on the Broselow tape and other pediatric
systems:
Gray—Newborns can come out looking a little gray, covered in goo. Interestingly, Broselow never wanted to call this zone gray; it
was meant to be sort of a “gray area” between 3–5 kg with various tubes/doses. But, having a drawer that looks gray and a section
on the tape that looks gray, everyone started calling it gray. Measure head to heels to get an ideal body weight right off the tape.
Pink (4 months old)—There are four letters in pink, and we want these little ones to be pink, warm, and sweet. Mom and dad are
also tickled pink when they (hopefully) start to sleep through the night.
Red (6 months old)—Three letters in red, and three letters in six (months).
Purple (1 year old)—By 1 year of age, these little ones will turn purple in one minute if you’re not fast enough getting what they
want!
Yellow (2–3 years old)—Terrible twos are usually yelling about something!
White (4–5 years old)—As 4- and 5-year-olds leave home for preschool and kindergarten, they are scared out of their minds, so they
turn white as a ghost.
Blue (6–7 years old)—“Little Boy Blue has six boo-boos” (6–7-year-olds are crazy on the playground and get lots of bumps, bruises,
and boo-boos).
Orange (8–9 years old)—“Orange you glad I eight [ate] the banana?” Kids start to love bad jokes at this age, so this is inspired by
the classic punchline, “Orange you glad I didn’t say banana?”
Green (10–13 years old)—This last zone is for kids going into double digits (10-plus years old). In the peds world these are the “jolly
green giants.”