When high-school student Ethan Milne submitted a school research project to the call for abstracts for ACEP14, he may not have realized he’d be one of the youngest presenters to give a talk in the history of the annual emergency medicine gathering. Ethan, who started 11th grade at Goderich District Collegiate Institute in Goderich, Ontario, this year, has bent his interest in medicine and technology to develop inventions with the potential to improve patient care in the emergency department. He and his father, emergency physician Ken Milne, MD, who writes the Skeptics Guide to Emergency Medicine blog (www.thesgem.com) and column for ACEP Now, recently spoke with Kevin Klauer, DO, EJD, ACEP Now medical editor-in-chief, about Ethan’s research, which will be presented during the 9:30–11:00 a.m. poster session on Monday, Oct. 27, 2014, at ACEP14 in Chicago.

Ethan Milne working on the PE Board

KK: Ken, when did you get a sense that Ethan was interested in developing [medical technology], and when did it becomes obvious that it was something that might benefit emergency medicine?

KM: Ethan’s always been interested in science. As I’ve seen him participate in school science fairs, I’ve been repeatedly impressed with the great projects that he comes up with, his ideas, and the experiments he’s performing.

KK: When did his research take a turn toward something that was applicable to emergency medicine?

KM: Last year. Ethan did a science fair [project] on assessing health literacy, and he created a voice-activated app to assess someone’s health literacy in approximately 10 seconds. You know it’s very, very busy in the emergency department. Communication is important, but so is time. If you can assess someone’s health literacy very quickly with an app, you could use that in the emergency department to tailor the information you’re providing the patient.

KK: How does it work at the bedside?

KM: There is a validated tool called the Rapid Estimate of Adult Literacy in Medicine, or REALM, short form where you read seven words out loud to the investigator, and if you pronounce a word correctly, you get a point, and if you don’t pronounce a word correctly, you don’t get a point. The points are added up, and it targets your level of health literacy. We would use this as a vital sign down in triage in a nonthreatening way: “Could you please read these seven words? And if you can’t read them, that’s fine. This is just going to help your doctor communicate to you better.” What Ethan came up with is automating it into an app.

KK: Ethan, how did you come up with the idea of doing the health literacy app? Did you come up with that idea all by yourself? Was there some influence from your dad?

EM: My dad had already done a study with REALM.

KM: We had done a research project, and it was very labor-intensive having a student do all this interviewing. Even with the brief validated tool of the REALM short form, it still was labor-intensive.

EM: And so I said, well, you can just automate it. Put it on a smartphone. We have voice recognition.

Figure 1. PE Board

KK: So this was the second generation of that project, taking good data and being able to apply it at the bedside. Tell us about the new project.

EM: I call it the PE Board, which stands for Pediatric Electronic Board. In an emergency situation where a child requires resuscitation, you can put them on this board, and it can tell you the child’s weight and then it connects with an app on your smartphone that tells you the amount of drug dosages, endotracheal tube sizes, and joules for resuscitation. I got this idea because right now the gold standard is the Broselow Tape, a length-based system to estimate the weight of a child. So far it’s worked really well, but recently kids have been getting bigger, and it’s been shown that the Broselow Tape can have up to a 10 percent error almost half of the time. I thought, “Why not just put a scale in there?”

KK: Tell me how you went through the process of starting and developing the PE Board and how this thing looks.

EM: The spine board [that we used as a template] is a really bright yellow. It has a border going all the way around the general outline and then on the inside it’s hollow, which is where we put the disassembled Bluetooth bathroom scale. There are four load cells placed strategically around a child’s midsection and their legs to get the most accurate reading. On top of the load cells is a bright metal plate that can be easily sterilized and then, on the very top of it, there is an LCD screen, which can show a child’s actual weight [see Figure 1].

KK: What was your biggest challenge developing this?

EM: I had two moments actually. One was when I was learning how. I’d never soldered wires before. When I was trying to rip apart the Bluetooth scale, there was a bit of an incident with solder where I plopped a whole glob of solder on top of the main circuit board, which was very scary.

KK: Tell me how you tested it to validate that it really worked and would be applicable in clinical care.

EM: That ties into the second time I said to myself, “Oh my gosh, I will never do this.” To validate the board, I had to go to London, Ontario, and to Dr. Richard Lubell, a community pediatrician working for Western University, to use his pediatric office as a testing ground. The sample size that we required for a validation study was 160 children, and at that point I said, “oh, no,” because I’d never done something on that scale before. But I did it. I stayed there for four days, and as every child came through Dr. Lubell’s office, I would invite them to participate in the study. I would weigh the child on a pediatrician’s scale and then on the PE Board, and I would record both results. I would also take the child’s height so I could estimate the Broselow Tape reading. Another reason why we picked that location was because there was a study done about the Broselow Tape in the exact same place, so it was kind of the same sample population.

KK: What is your future plan for your invention?

EM: One thing I actually did was to submit the abstract to ACEP and present it. I wanted to be published. It was always my goal to be published before I got out of high school. Another thing I want to do is waterproof the board. Right now, it’s just made out of wood and metal, and the wood, in a rainy condition, could get rotten. I would like to make a plastic model for the PE Board. Last of all, I’d like to patent the board so I could mass-produce it.

KK: What do you think you want to do when you get out of high school? What are your plans?

EM: Well, I am fairly certain that I do want to go into medicine. As for what type, I’m not really certain. I’ve grown up in an environment where my dad is an emergency doctor, so that’s definitely an option. I don’t know yet. It’s too early to decide.

KM: Well, you are only 15.