Loyola EMS September 2015 CHILD BIRTH AND THE EMD

Transcription

1 Loyola EMS September 2015 CHILD BIRTH AND THE EMD

2 OBJECTIVES Anatomy and Physiology of the pregnant female Anatomy and Physiology of the Neonate and Fetus Protocol Review

3 EMD AS A MEDICAL PROFESSIONAL There is probably no medical profession other than emergency medical dispatching in which the core time for patient evaluation and decision making is routinely around one minute, and more is potentially at stake on a case-by-case basis (Clawson et al, 1996)

4 EMD AS A MEDICAL PROFESSIONAL EMDs essentially practice their profession via remote control, dealing nonvisually with someone who is generally not the patient. The lack of direct patient access requires EMDs to rely heavily on interrogative skills. However, with tested protocol-driven questioning, EMDs can successfully elicit the necessary information to dispatch appropriate personnel with adequate information

5 EMD PROFESSIONALISM Comes from being : Customer-Service oriented rather than complaint driven Calm and cool demeanor despite caller disposition Keeping current by seeking on-going dispatch education Submitting ideas for future protocol changes

6 I DIDN T KNOW I WAS PREGNANT

7 PHYSIOLOGIC CHANGES OF THE WOMAN

8 STAGES OF DEVELOPMENT

9 STAGES OF LABOR Stage One is the Dilation stage Starts with the onset of true labor contractions Dilation of the cervix begins until fully dilated (opened) Mucus Plug is discharged (Think of this like a cork protecting the baby from disease)

10 THE 911 CALL FOR A WOMAN IN LABOR

11 PROBLEMS ASSOCIATED This is the 911 caller that is panicked, maybe a first time parent. Important to count contraction rate and length of time. 1 st time pregnancy is imminent if contractions are 2 minutes apart Subsequent Pregnancies are imminent if contractions are 5 minutes apart

12 HIGH RISK PREGNANCIES Per Loyola Standards a pregnancy is high risk if: Maternal drug use Teenage pregnancy History of diabetes, high blood pressure, heart disease or other pre-existing conditions Pre-term Labor (before 37 weeks) Previous Breech or UN-planned C-section Multiple Births

13 COUNTING CONTRACTIONS start counting from the beginning of one contraction to the beginning of the next.

14 STAGES OF LABOR Stage Two is the Expulsion Stage Get ready to catch. Increased urgency to push Female may feel like she has to make a bowel movement Baby is delivered at the end of this stage

15 PROBLEMS ASSOCIATED Get out your Child Birth Instructions Then: TAKE A DEEP BREATH 95% of all births even out of hospital have no life threatening complications.

16 OK HERE WE GO

17 PRE-ARRIVAL INSTRUCTIONS We are going to have one of two outcomes with a prehospital birth Normal, with no life threatening complications OR An Absolute disaster

18 PRE-ARRIVAL INSTRUCTIONS Get Supplies- Towels and a shoe string or cord. You may have to get the caller to get creative **DO NOT give this instruction to a first party caller in labor.** Have the female lay on the floor or couch. NOT the toilet no matter how bad they say they have to go.

19 PRE-ARRIVAL INSTRUCTIONS If the head is exposed, we will likely have an uncomplicated birth. The goal of our instructions are to reduce the chances of dropping the baby because the baby comes out too fast. Tearing the delicate membranes of the female

20 PRE-ARRIVAL INSTRUCTIONS For the infant our goal is: Safe delivery by controlling speed of ejection Keep the baby warm Dry the baby (the reason for towels) Provide for ABC s through stimulation of the baby. This is done by cleaning out the nose and mouth of the baby. Clamp the cord. (This is where the string comes in)

21 COMPLICATIONS Every once and a while we get a complicated delivery This is a high risk and low frequency event We need to practice our pre-arrival instructions because the time to practice is not when a female and her infant are in distress

22 BREECH DELIVERY If any body part other than the head is presenting, we have a breech birth. There are various types: complete, incomplete and frank breech birth Complete breech means the baby s buttocks comes out first. Incomplete breech means the baby has either a foot on knee comes out first

23 BREECH

24 BREECH BIRTH INSTRUCTIONS Focus is on slowing down the birth. Prop the mother so that while laying down her hips are elevated. Or have the mother pull her legs up to her chest. Support the baby as it is born until the head delivers

25 STUCK HEAD

26 STUCK HEAD INSTRUCTIONS Have the female push very hard with the next contraction Sometimes standing and squatting help with positioning for this problem. However, give instructions to have a soft area for the baby to land if they deliver quickly, preferably have the mother no more than a foot above the surface.

27 PROLAPSE CORD

28 STAGES OF LABOR Stage three is the placental stage Starts after birth of baby and ends when the placenta is delivered.

29 PLACENTA Delivers in about minutes after the birth. In our area it is unlikely that you will have time to reach this instruction. But you never know because we have floods, wind events and blizzards. Place the placenta in a towel. They MUST bring it to the hospital

30 OH, ONE MORE THING There may be multiples. So be ready to give instructions more than once.

31 THINGS THAT MAKE YOU GO HMMM?

32 PREGNANCY PROTOCOL REVIEW The Pregnancy/Childbirth Card is for 911 calls related to the pregnancy only Does not cover things like: vomiting, nausea, flu-like symptoms, trauma, or MVC s For related issues like: vaginal bleeding, miscarriage, labor or water bag broken

33 REVIEW CONTINUED 1 st pregnancy is slower than subsequent ones (generally) Abdominal cramping in a pregnant woman should be considered labor (may result in miscarriage or birth) Attempting to prevent or delay a birth can cause death or brain damage to the baby.

34 REVIEW CONTINUED A Baby that is just born or was born just prior to the 911 call is still handled under the pregnancy card This is because there are many important steps covered on this card: Drying, warming the baby Clamping (Tying off) the cord Delivering the placenta Controlling bleeding of the mother through nursing the infant