During a career in medicine that has spanned nearly 30 years, John Hoyle, MD, has focused his research efforts on one mission – improving prehospital care for children.
Now, that important work is being buoyed by a $1.37 million grant from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality that was awarded to WMed this month. The funding will fuel a three-year study by Dr. Hoyle and an interdisciplinary team made up of researchers from the medical school, Western Michigan University, University of Michigan, and Lansing Community College.
The research project, “Augmenting the On-scene Medic (ATOM): Development of a head-mounted display application to reduce prehospital pediatric medication errors,” is a first-of-its-kind study that officially launched April 1 and will run through March 2026. In addition to Dr. Hoyle, who is serving as principal investigator, the research team for the study includes Tycho Fredericks, PhD, professor in the Department of Industrial and Entrepreneurial Engineering at WMU and chief of the Division of Medical Engineering at WMed; Autumn Edwards, PhD, professor in the School of Communication at WMU who also serves as co-director of WMU’s Communication and Social Robotics Labs; Bryan Harmer, PhD(c), a critical care paramedic, professor of Emergency Medical Services at Lansing Community College, and adjunct clinical assistant professor at WMed; Guan Yue Hong, PhD, associate professor in the Department of Computer Science and College of Engineering and Applied Science at WMU; Prashant Mahajan, MD, MPH, MBA, vice chair for the Department of Emergency Medicine and professor of Emergency Medicine and Pediatrics at U-M, and Vitaliy Popov, PhD, assistant professor of Health Sciences at U-M Medical School, assistant professor in the U-M School of Information, and director of Learning Services and Technology for the Clinical Simulation Center at U-M.
Over the next three years, the research team will work to develop an application for the Microsoft HoloLens, a popular wearable augmented-reality technology that will help paramedics more accurately deliver medications to young patients, said Dr. Hoyle, who serves as the medical school’s assistant dean for Simulation and is a professor in the departments of Emergency Medicine and Pediatric and Adolescent Medicine.
“We’re going to use the functionality of the HoloLens to read drug vials and double-check doses pulled up in syringes, in addition to helping paramedics obtain a patient’s weight and calculating the correct drug dose for a patient,” Dr. Hoyle said. “This has never been tried before.”
Dr. Hoyle said he and his team worked an entire year on the grant application for the study before submitting the proposal to the Department of Health and Human Services in May 2022. The study’s objective – to reduce medication-dosing errors that occur when children are treated by emergency medical services – is a lofty and critical aim as errors associated with pediatric medication administration in EMS are alarmingly high, Dr. Hoyle said.
While EMS calls involving critically ill children are relatively rare, making up just 1-3 percent of all emergency encounters for paramedics, the incidents are often intense and studies have shown that there is a 31 percent error rate across all drugs administered to children by EMS. Medications such as midazolam and fentanyl have even higher rates at 61 percent and 35 percent, respectively.
Dr. Hoyle said previous research and strategies aimed at reducing the medication dosing errors have proven futile while other cognitive aids for paramedics have often fallen short because they are simple reference tools and do not address all causes of the errors.
In 2016, Dr. Hoyle, along with Bill Fales, MD, professor in the Department of Emergency Medicine and chief of the Division of EMS and Disaster Medicine at WMed, were awarded a grant by the Health Resources & Services Administration for the Michigan Pediatric EMS Error Reduction Study (MI-PEERS), which sought to implement a drug dosing safety system to decrease the high rate of medication-dosing errors for children treated by EMS. As part of that research, several EMS agencies in Michigan used a pediatric patient checklist and dosage cards, and took part in regular trainings on pediatric drug dosage calculations.
“We found that it helped when crews used the checklist but we didn’t see that much of a difference in dosage errors and they still occurred at a rate of about 25 percent,” Dr. Hoyle said. “We really want to get that number to five percent or less and this technology offers some things you can’t get any other way, including an independent augmented check of everything.”
The idea for the new research project using the Microsoft HoloLens started to take shape in 2021 when Harmer, who is a doctoral candidate in the Interdisciplinary Health Sciences PhD Program with in the College of Health and Human Services at WMU, approached Dr. Hoyle after reading his previous research on pediatric dosage errors in the prehospital setting and proposed the development of an augmented-reality device application to combat the ongoing issue. Those conversations led to discussions with Dr. Mahajan at U-M and the constructing of the current research team as Dr. Hoyle began writing the grant proposal.
“Bryan deserves a lot of credit for this,” Dr. Hoyle said. “Using technology like this offers the opportunity to make a change for the better and bring that error rate down. It can be a disruptive technology with that disruption being a very positive development.”
“As a doctoral student, this has been a fantastic learning experience,” Harmer said. “Dr. Hoyle has been a great mentor and I am very honored to be part of this research team. I am confident that this technology will be able to successfully address this alarming issue. In the future, I think there are other ways it could help improve care in EMS by augmenting clinical performance.”
Dr. Hoyle said the research team’s path to success over the next three years will be rooted in a thorough examination of the characteristics of pediatric medication administration and the use of a comprehensive design thinking process to develop a prototype application for the HoloLens, examine usability of the prototype, and test the safety and efficacy in a randomized controlled trial.
Over the next year, Dr. Hoyle said he and his team will be gathering background information and developing the application for the HoloLens. He is hopeful that pilot testing of the application will occur in Year 2 of the grant with a randomized controlled trial in six Michigan cities during Year 3 with an emphasis on understanding the end users and the tasks they need to complete to be successful.
If all goes well, Dr. Hoyle said the application could be ready for distribution by some time in 2027.
“This has been my research focus my entire career,” Dr. Hoyle said. “This is a difficult process for paramedics because they don’t get large amounts of pediatric training and the encounters in the field are rare so they have limited experience. This new technology has the chance to disrupt the high rates of pediatric dosage errors and finally bring those numbers down.”