Wisconsin Emergency Medical Services for Children (WI EMSC) has launched a quality improvement project focused on increasing the proportion of pediatric EMS encounters with documentation of estimated weight in kilograms. Thanks to a generous funding opportunity from Cars Curing Kids, part of this initiative includes providing all ambulances and emergency medical responder (EMR) groups in the state with a retractable, Broselow-compatible weight measuring tape and a corresponding reference card. These resources will help EMS personnel increase weight documentation and rapidly assess correct medication dosing and equipment sizes for pediatric patients.

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* 1. What is your name?

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* 2. What is the name of your EMS agency?

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* 3. What is a phone number we can use to reach you?

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* 4. What is an email address we can use to reach you?

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* 5. If you are part of an EMR (emergency medical responder) group, would you like to receive one Broselow-compatible weight measuring tape?

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* 6. If you are part of a transport EMS agency, how many ambulances does your agency operate? (Note - you will receive one Broselow-compatible weight measuring tape per ambulance.)

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* 7. If you are part of a transport EMS agency, would your agency like to receive one Broselow-compatible weight measuring tape per ambulance?

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* 8. List the mailing address where WI EMSC should send your pediatric weight measuring tape(s):

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