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KALAMAZOO, Mich.—Saving the lives of children in emergency situations requires quick thinking and accurate decision-making. Unfortunately, administering medications to young patients can be a challenge for paramedics, who must often read tiny drug labels and calculate dosages on the fly. 

That's why an interdisciplinary team of  researchers from ɫɫ�� Michigan University, ɫɫ�� Michigan University Homer Stryker M.D. School of Medicine (WMed) and the University of Michigan are working to develop a head-mounted display application using Microsoft HoloLens that could one day help paramedics in these situations. 

With a $1.37 million grant from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, the team is laying the groundwork for a new technology that could make a big difference in the world of prehospital care for children. The project, titled “Augmenting the On-scene Medic (ATOM): Development of a head-mounted display application to reduce prehospital pediatric medication errors,” began in April 2023 and will run through March 2026.

“​​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,” says Dr. John Hoyle, the project's principal investigator, who serves as WMed's assistant dean for simulation and is a professor in the departments of emergency medicine and pediatric and adolescent medicine. “This has never been tried before.”

Critical pediatric cases make up just 1-3% of paramedic emergency encounters, yet studies show a 31% error rate in all drugs administered by EMS to children, with midazolam and fentanyl having even higher rates at 61% and 35%. Beyond that, Hoyle says that attempts to reduce medication dosing errors have been unsuccessful in the past, and existing cognitive aids for paramedics have not fully addressed the root causes of these errors.

“This has been my research focus my entire career,” says Hoyle. “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.”

Building the ATOM team

The genesis of the new research project using the Microsoft HoloLens can be traced back to 2021, when Bryan Harmer, a doctoral candidate in ɫɫ��’s College of Health and Human Services Interdisciplinary Health Sciences Ph.D. program, approached Hoyle. Harmer had read Hoyle's previous research on pediatric dosage errors in the prehospital setting and proposed the development of an augmented-reality device application to address the issue. These initial conversations with Hoyle ultimately led to the construction of the current research team and the grant proposal.

“Bryan deserves a lot of credit for this,” says Hoyle in a news release. “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.”

ɫɫ�� Drs. Tycho Fredericks, Guan Yue Hong, and Autumn Edwards, and University of Michigan Drs. Prashant Mahajan and Vitaliy Popov round out the team of researchers for this pioneering study, bringing expertise from a range of fields.

Given his focus on healthcare technology development, Fredericks, a professor in the College of Engineering and Applied Science’s Department of Industrial and Entrepreneurial Engineering, director of the Human Performance Institute, and program chief and professor in the Division of Medical Engineering at WMed, is ideally suited for this project.

“I have known Dr. Hoyle for several years, and I am thrilled to be a member of this cross-disciplinary team addressing such a purposeful challenge,” says Fredericks. “Our team is well positioned to pursue new paths and build innovative solutions. This is what we live for in academia.”

Also contributing to the project from the College of Engineering and Applied Sciences is Hong, associate professor in the Department of Computer Science. For this project, Hong and her students will develop the mixed reality application for the head-mounted device, as well as a desktop application for project management and administration.

“My students are thrilled to be supported by the grant to develop state-of-the-art and AI-enabled mixed reality applications for emergency medical care doctors who save lives which makes the project so meaningful,” says Hong. 

With Edwards on board, the project is also tapping into the expertise of a ɫɫ�� School of Communication professor and co-director of the University’s , who specializes in human-machine communication. Her focus is on optimizing the user experience, interface and usability of the head-mounted display application, taking into account the phenomenon of cognitive load.

“How do we maximize the helpfulness of the information in visuals, but make sure it doesn't distract or freak people out in high-pressure situations?” says Edwards. “That’s a lot of what I will be doing—trying to figure out the best ways to graphically present the information so it doesn’t conflict with the goals.”

Beyond the immediate goal of reducing pediatric prehospital care dosage errors, Edwards is also interested in exploring the broader social and communication implications of integrating augmentation devices in healthcare teams and patient care settings.

“This could really change the communication dynamics between team members and patients," says Edwards. "It is fascinating to think about how children might respond to EMS providers who kind of look like Cyborgs as they exit the van, or how (using the technology) might affect people's status within a team."

The team will be busy over the next year gathering background information and creating the HoloLens application. Pilot testing of the application is expected to take place in the second year of the grant, with a randomized controlled trial planned for the third year in six Michigan cities. Throughout the project, the team will prioritize understanding the end-users and the tasks they need to complete. If everything goes according to plan, the application could be available for distribution by 2027.

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