A two-year-old girl who accidentally swallowed an adult dose of an opioid medication has just been picked up by an ambulance and is on her way to the emergency department at Children’s Hospital of Wisconsin. Her respirations are depressed and, without proper medical care, she is in danger of dying. The paramedic has called the emergency pediatric team to let it know that a poisoned child is on the way. The paramedic doesn’t know much about the child’s medical history, but he does know that she just turned two.
This scenario is one of many that the pediatric team at Children’s Hospital encounters regularly. A child might require resuscitation because of a poisoning, a drowning, a house fire or because of Sudden Infant Death Syndrome (SIDS). In all cases, the doctors must work quickly, knowing that delivering timely and effective treatment may make the difference between a good and poor outcome for their young patients. A child’s life may be at stake.
With the help of a Smartphone app recently developed though collaboration between the Medical College of Wisconsin (MCW), Children’s Hospital and he UW-Milwaukee App Brewery Lab, the pediatric team prepares carefully for the threatened toddler to arrive.
By entering the child’s age into the app, the doctors are quickly able to obtain the correct dose of medicine needed to save the child’s life. Once the app determines the correct dose, based upon the child’s age and weight, the emergency department nurses and pharmacists can prepare the medication for the patient before she even arrives in the emergency department. Once she is there, the doctors can calmly and confidently give the child the proper dose of the lifesaving medication.
It wasn’t always so straightforward.
Before the development of the app, physicians were required to do manual calculations while attending to the patient. In resuscitation scenarios, every second counts, and physicians have only one chance to get it right. Dr. Amy Drendel, a pediatric emergency physician at Children’s Hospital, along with her colleagues—physicians Michael Meyer and Danny Thomas and nurse Robin Saxe, saw the need for such an app and proposed it to MCW Dean Joseph E. Kerschner, who was running a competition among physicians from different fields for the best proposal. The winners would be funded to have their proposal developed by the App Brewery. Dr. Drendel’s team was one of the winners. The App Brewery is a lab at UWM that provides hands-on training for students who develop useful apps for the community and for researchers at the university.
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We were interested because we perform resuscitations on babies and young children, and much of what we do in terms of choosing the right dose or the right size equipment requires you to do calculations or remember proper sizes because a child’s physical size changes so much between birth and 18 years,” Drendel says. “In a stressful resuscitation scenario, that is not an easy thing to do.” She believes that the app has resulted in better care for her young patients. “It definitely makes care more standardized and efficient,” she says. “It takes away a lot of stress because doing those calculations can be stressful in an already stressful environment.”
Dustin Hahn, project manager of the App Brewery, says working on the app for Children’s Hospital has been one of the most rewarding experiences he has had since joining the lab in 2015. “It is one of the most simple, most impactful and most widely talked about apps that we’ve done,” Hahn says. “When can you come in at the end of the day as a computer scientist or as someone in computer technology and say, ‘Wow, without this app, who knows what would have happened?’”
Drendel says negotiations are ongoing regarding the app’s future, but hopes that it will eventually be available to other hospitals for free at the App Store, once negotiations are complete. “Our hope is that this app will make a difference in advancing the health and well being of all children and really provide high quality care and make a difference in their outcomes,” Drendel says. Because of its simplicity, she hopes that, one day, it might be used by paramedics when they come to the rescue of a child requiring resuscitation.
She also is hopeful that it may be used in non-pediatric emergency rooms, where resuscitations are not common. “At Children’s, we’re used to handling kids, and we commonly do these calculations; but in an adult emergency room, 10-20% of the population is pediatric, and it is much more rare to have to face these resuscitations,” Drendel says. “The adult emergency rooms could also use this app and be prepared to take the best and safest care of kids.”
Hahn believes that, in addition to serving the community and local businesses by developing helpful technology, the App Brewery also gives students like Evan Timmerman real-world experience that helps him build his soft skills. (Timmerman, a paid student intern at the App Brewery, took about 3 to 4 months to build the resuscitation app.) As an App Brewery intern, Timmerman learned to interact with an employer or client and also how to navigate and negotiate—skills that might not be taught in the lecture hall. Timmerman agrees.
“It was a fantastic experience for me when I first started at the App Brewery,” he says. After having switched his major from physics to computer science the semester before, Timmerman discovered a new mindset and outlook in the world of industrial app development. “The App Brewery gave me more scope into this whole huge world of development in computer science and software engineering.” He likes the fact that the internship helps prepare students for graduate school or employment. In his case, he wants to get a job in the field.
“There’s very high demand for the computer science field,” he says. “My ideal job market would be in the health care field. Working here at the App Brewery, I got a huge appreciation for technology in the health care area in hospitals. Looking for different opportunities in that area would be my highest interest.” Timmerman graduated from UWM in May.
The App Brewery has developed a number of other apps, including one that self-guides visitors through the Streets of Old Milwaukee at the Milwaukee Public Museum, as well as one that helps parents track the books they have read to their children in the 1000 Books Before Kindergarten program. It has also worked with the Sojourner Family Peace Center to develop an app that leaves no browsing history—useful to women living in fear in abusive home situations whose spouses might retaliate if they found out about an association with the Sojourner Family Peace Center. Another app helps coaches and parents track and evaluate concussion symptoms for athletes using the SCAT3 checklist from the 2012 Consensus Statement on Concussion in Sport.
The App Brewery typically employs five paid interns and four full-time staff people. Their funding comes from UWM, as well as from the fee the Brewery charges its clients for app development. Clients like MCW often receive National Institutes of Health grants for the projects they work on with the App Brewery. Since its inception in 2013, the App Brewery has worked on some 15 projects for the college.
The App Brewery, now housed on the fourth floor of the Physics Building at UWM, began life at the Zilber School of Public Health, which was once part of Pabst Brewery (hence the “brewery” nomenclature). The App Brewery actively seeks proposals from the community, which are carefully evaluated. Some considerations include whether the proposed projects would be good résumé builders for students and if they would be sound investments for the university.
