References
A cross-sectional study of paramedic management of out-of-hospital obstetric emergencies
Abstract
Background/Aims
Most birth-related ambulance calls occur without difficulty, but in some cases, complications can arise. Paramedics’ involvement in birth is infrequent; therefore, the knowledge and skills required to manage complications can atrophy over time, particularly without educational interventions. This may impact outcomes. The study's aims were to measure the knowledge, attitude, and practice of paramedics in managing obstetric cases.
Methods
This cross-sectional questionnaire-based study was carried out with 264 paramedics. Spearman's measure of correlation was used to observe linear correlations between ranks of the observations.
Results
The majority of participants were advanced care paramedics (81.1%). Participants reported infrequently attending births in the community, with under half feeling confident in managing these (44%). Antenatal complications and trauma in pregnancy were self-reported areas of weakness; this was consistent with assessed knowledge.
Conclusions
Paramedics self-reported infrequently responding to obstetric calls and the majority lacked confidence in managing these. Few indicated an excellent level of obstetric knowledge, reporting a desire to receive more education in this area.
Implications for practice
When paramedics lack confidence in managing obstetric emergencies, it can lead to delayed decision making, inadequate assessment, increased error rates and adverse maternal and neonatal outcomes.
Global maternal death rates are falling but still remain ‘unacceptably high’ (World Health Organization, 2024). In Australia, the maternal mortality rate is 5.5 per 100 000 births (Australian Institute of Health Welfare, 2023). Although these rates are comparatively low compared to other countries, official reports suggest that improvements in care could have prevented deaths in a considerable proportion of these patients (Australian Institute of Health Welfare, 2023). Complications leading to mortality are relatively consistent across these countries, with thromboembolism, hypertension, sepsis and haemorrhage cited as some of the most common causes of direct maternal death (Shakespeare and Knight, 2015; Verstraeten et al, 2015; Australian Institute of Health Welfare, 2023). Some are also reported as intrapartum complications experienced during the paramedic care of obstetric patients (Flanagan et al, 2017). Notably, across Australia and the UK, between 15% and 33% of maternal deaths occur during the prehospital or emergency department phase of care (Knight et al, 2021; Australian Institute of Health Welfare, 2023). These data demonstrate that despite careful maternity planning, serious complications can and do occur outside the planned place of birth.
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