OneDose Protocol App Rollout

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Why

• Other protocols distributions have limitations

Safety

• Medication calculations include volume to be drawn in addition to the dose
• Provides guardrails for treatment by limiting what is displayed to information relevant to your case

Management

• Updates are automatic
• UH has complete control over updates and issues can be resolved quickly

Ease of use

• Limits scrolling for information
• In true app form, not just a pdf view

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Overview

• New app program to replace old app or .pdf
• Available on android, iOS, or web browser
• Breaks down .pdf version within the Onedose framework, allowing to easy access and easy searching
• UH providing “professional” level access – base protocol access
• Departments may choose to get additional features such as EPCR integration on cot scale integration for real time weights – contact Hinckley Medical Directly

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Overview - Departments

• Departments will have a “generic” login for department level phones, pads, and devices – not connected to any user
• Departments may have differences in their use of the application – ALS vs. BLS, Other purchased features, etc.
• Departments have own department code unique to them
• Departments have own pin # unique to them
• Both department code and pin needed to gain access to the department's “copy” of the app
• Departments can drop user access if employment relationship changes

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Overview - Users

• Individuals can have access to their agency's “protocol” with account creation
• User is associated with a department
• User can be associated with multiple departments
• Toggle between departments in the app if multiple

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Overview Continued – EMS Coordinators

• Department login information needed for first time enrolment will be available on a shared spreadsheet for EMS Coordinators / EMS Educators
• Give access to departments at time of training
• Have responsible party at department catalog this information for new members / lost / forgotten
• Department level administration / login will be targeted to administrators in other correspondence / training - upcoming

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Still in Progress

• This is in its infancy and will require tuning as we go
• Expectation should not be perfection out of gate
• Please report issues for review a correction
• There is a report issue page within the app – Appendix : Issue Reporting & Feedback
• https://forms.gle/cKkwEgBTPXJZ8Y7A8

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UH Custom WEB Landing Page for New Users

https://hinckleymed.com/university-hospitals-ems/

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Updates

• Every time the app is re-opened it checks for new updates
• Downloads new updates
• Make sure that the app is completely closed or restart device daily then re-open prior to need to prevent any on scene delay – may be running in background
• Likely to be numerous improvements in the first few months

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Individual User Login

Start by Creating a OneDose Account

1. Download the OneDose app from the iOS App Store or Google Play Store.

2. Open the app and click on New User? Sign Up.

3. Follow the prompts to enter your Department Code and PIN.

4. Select the agency or agencies to which you would like to subscribe.

5. Follow the instructions, including entry of a valid email, username, first name, last name, PIN, and password. Store this information securely for future access.

6. Once the account has been created, log in for the first time to sync protocols and begin use.

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Login Screen

• Initial login screen
• Sign up as new user

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*examples shown on the vastly superior android platform, actual screen view may vary slightly on the “other” product. Of course, this is the opinion of the author and does not reflect any opinion of University Hospitals.

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New User Screen

• Department code per the online list available to UH EMS Coordinators and Educators

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• PIN number per the online list available to UH EMS Coordinators and Educators

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New User Screen

• Top of form should show the department you are trying to gain access to based on the department code and PIN

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• Enter basic information

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• Create YOUR pin # for access levels in the app later on

Department

You Create PIN

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New User Screen – Cont.

• Scroll down on new user screen to create Password

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• Then “Create Account”

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• Will get a notification if the username is already taken

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You Create PW

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New User

• Go to your email for validation code #
• Enter in next screen

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The UN You Created

Check your email

The CODE provided in the email

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Authentication Process

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App Home Screen

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Breaks down into 5 sections

• Medications – Searches by medication then allows to bring up needed protocol
• Equipment – Searches by equipment then allows to bring up protocols where used
• Electrical – Searches by electrical therapy then allows to bring up protocols where used
• Vital Signs – Brings up vital sign ranges for a selected age / weight
• Contacts – Brings up contact list of Hospital ED and other numbers
• Patient Inputs – Allows for age / wight entry for specific results
• Protocols - Where the protocol as a whole lives

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Medications

• Clicking a Medication show protocols in which that medication is used
• Paired protocols – app vernacular

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Medications Cont.

• Clicking a paired protocol brings up the protocol page
• The calculation tab show in “relative order” the medications to give to that case
• Entering weight-based age or weight in the patient inputs +add button, will show any weight-based medication calculations

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Equipment

• Clicking an equipment type displays all protocols that the devices is paired with
• Clicking the individual protocol brings up the PDF/Calculation as shown in the last slide

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Electricals

• Displays different electrical therapies
• Clicking on the therapy displays the paired protocols
• Clicking on the paired protocols displays the PDF/Calculation page as in other sections

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Vital Signs

• Initial screen has generic information until weight is added
• Auto scale when a weight is entered in the patient input +Add

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Contacts

• Phone book for uploaded contacts
• Adding regional ED phone numbers and other important numbers
• Can dial from this list

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Protocols

• Views protocols same order as the .PDF for complete review
• Clicking a category brings up all protocols in that category
• Clicking a protocol brings up the PDF/Calculation page like other sections

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Weights / Ages – Patient Inputs

• +ADD button for patient inputs brings up multiple selections to focus treatments
• Age
• Weight – Direct Entry
• Weight Formula
• Color Coded System

Add your variables

Click Add

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Weights / Ages – Patient Inputs

• Selected inputs displayed at top of the Patient Inputs Tab as well as any page where they may be relevant to calculations.
• Click on the patient input and get a selected check to add another variable or delete the input (-) button

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Sample Calculation

• Heparin
• 50 kg pt

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Computer Browser

• Browser based – requires internet connectivity at login
• Onedose.hinkleymed.com
• Similar user interface to the app

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Scenario 1

• You are responding to a dialysis center for a patient with bradycardia
• You identify that hyperkalemia is a top suspect for this based on the symptoms and the patient likely being a dialysis patient
• You want to refresh yourself on the medications needed to treat this

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• What protocol section would this be found in current protocol?

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Scenario 1 – Hyperkalemia Protocol

ADULT – Medical Emergencies

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This information is still relevant in the Onedose App

• From home screen select “Protocols” icon
• Select Adult Medical
• Select Hyperkalemia

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Review the hyperkalemia protocol

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Scenario 1 Hyperkalemia Meds

• Click on calculations for hyperkalemia
• You will see albuterol as the first (easiest) treatment
• Fixed Dose 10 mg and 12 ml of 2.5/3ml concentration albuterol unit dose
• Click on albuterol for special instructions
• Next medications are calcium preparations
• Calcium chloride normally provided
• Fixed dose 1 gram
• Note normal saline and sodium bicarb notated a “0” ml’s
• Weight based
• Use PATIENT INPUTS to get values

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Scenario 1 Hyperkalemia Meds

PATIENT INPUTS

• You have not seen the patient yet so one could use an average weight ex 100kg or select an adult level weight range in the color chart (greens at bottom)
• Let's use regular adult weight by selecting the +
• Notice the dose and the volume now populate for normal saline and sodium bicarbonate

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Scenario 1 Continued

• You arrive on scene and attach an EKG monitor, and obtain a 12 lead EKG

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Scenario 1 Continued

• You confirm your suspicions of hyperkalemia being the cause
• However, you realize that your initial estimate of 70 kg is light
• The patients chart indicate that the patient is 310 lbs.
• Return to PATIENT INPUTS
• Direct enter the weight in pounds
• Notice the auto calculation of kg and the re-calculation of the medications

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• Operational reality – how much is this patient actually going to get as a sodium bicarbonate first dose?

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Scenario 1 Continued

100 meq / 100ml

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There are only 2 sodium bicarbonate prefilled syringes in the drug box

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50 meq / 50 ml per box

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Scenario 2

• You arrive on a man down call and find a middle-aged man down and breathing quickly with audible wheezing. He is not responsive to verbal stimuli. You note red blotches all over the patient and you cannot palpate a radial pulse.

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• You and your partner appreciate that this is anaphylactic shock and discuss epinephrine preparations.

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• What section would this anaphylactic protocol normally be found in?

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• From home screen select “Protocols” icon
• Select Adult Circulation / Shock
• Select Anaphylactic Reaction / Shock

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Scenario 2

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• Notice 2 concentrations noted
• IM/NEB concentration
• IV/IO concentration
• Notes as to which concentration to use for which case anaphylactic reaction vs shock
• Use the shock concentration
• Selecting this give additional warnings and instructions

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Scenario 3 - Shock

You are treating a patient with septic shock. You have already bloused the patient with normal saline. The blood pressure initially improves but the last two blood pressures are beginning to fall. You recognize that this patient is in a distributive shock that would benefit from a vasopressor. Realizing that push dose epinephrine is the intervention of choice, you open your app to validate the proper mixing and dosing.

You know the medication, we just need to validate the dosing

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• From home screen select “Protocols” icon
• Select Medications
• Select Epinephrine Pushdose Dilution
• Select Septic Shock for the Dose

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• BUTTTTT……You still want a reminder on how to mix the medication

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Scenario 3 - Preperations

• Select paired protocols
• Select Epinephrine Pushdose Dilution
• Also see Epinephrine Concentration and use chart

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Notes:

There are MULTIPLE EPINEPHRINE medication entries

• Epinephrine IM/NEB (1mg/ml)
• Epinephrine IV/IO (1mg/10ml)
• Epinephrine Pushdose Dilution
• Epinephrine Autoinjector Adult
• Epinephrine Autoinjector Jr. Peds

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Scenario 4 - Seizure

• You are dispatched on a seizing child. Enroute dispatch advises that the seizure has stopped, and the child is breathing. Upon arrival the father comes running from the house yelling that the seizure has started again and the child is turning blue.

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• The seizure persists after suppling supplemental oxygen and PPV.

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• Your partner is working on an IV.

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• Using your APP lets find an appropriate dose of midazolam for the kiddo
• Dad does not know how much the he weighs, but does know the child is 4 years old

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Scenario 4

• From the home screen select PATIENT INPUTS
• Use the slider bar in the age formula to slide to 4 years
• Press the +
• Now select medication
• Select midazolam
• Select pediatric seizure
• Select calculation
• You will have both IV/IO and IM/IN dosing options calculated for you

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Scenario 4 - Continued

• The IV is still not in place.

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• You want administer IN midazolam per the dosing calculator
• What syringe is best to draw up this volume?

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• Are we missing anything?
• Click PDF and review pediatric seizure protocol

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Scenario 5

• You have responded to Let's adult patient with Addison's disease
• The patient presents with severe nausea and vomiting, is confused and is hypotensive
• You recall that these patients often have rescue steroids for just such and occurrence and ask about their hydrocortisone. Sadly, they do not know where it is.
• Let's do a search of the whole protocol to fine keywords

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Scenario 5

• From the main screen select protocols
• In the top search bar, type Addison
• You will see search results with highlights of the matching results
• Select one to see the results

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Multiple agency access

• Providers who work for multiple agencies will need to request multiple agency access
• We are working with Hinckley to make this process easier in the future
• Use this form to request multiple agency access
• Remember, there may be differences between agencies if the departments choose to use any other Hinckley Medical options
• https://forms.gle/HzmE66RMiCCEUWhXA

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Webinars

Hinckley Medical will have additional training webinars in the beginning of 2025 to aid in training those who may miss this training

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• Tuesday Jan 21 @ 10:00 AM EST:
• Wednesday Jan 22 @ 10:00 AM EST: 
• Tuesday Jan 28 @ 3:30 PM EST: 
• Thursday Jan 30 @ 3:30 PM EST: 

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