bstone
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Does anyone know of any "regular", on the street ambulance (ALS or BLS) that carries a fetal heart monitor on it as part of the "normal" equipment package?
Fetal heart monitors?
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DrankTheKoolaid
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We carry portable doppler units on our trucks, not full FHM though
We carry portable doppler units on our trucks, not full FHM though
abckidsmom
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We carry them too.
WuLabsWuTecH
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None of the regular ambulances around here carry fetal heart monitors... I don't think is a Basic, Intermedia or Advanecd skill to assess and treat prenatal conditions except for that of the mother (eclampsia, etc)
ResTech
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Is it a good idea or even necessary to be checking for these in the field? I can only imagine parents reaction when you tell them you cant find fetal heart tones when really its just because a provider doesnt know exactly where to position the doppler.
DrankTheKoolaid
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Yes it's a great idea to have them on the trucks and you can teach any monkey to use them. There great for assessing distal pulses also by the way. Every OB patient should have FHT obtained, and any woman laboring should have them performed before during and after to assess for fetal decelerations. True there isn't a whole lot we can do for the patient but what it can help you decide is the destination. If there are no decel's im more then happy to transport an hour + where the OB docs are and deliver en route, If the child is decelerating i'm going to the closest ER possible and let the higher trained deal with it.
Yes it's a great idea to have them on the trucks and you can teach any monkey to use them. There great for assessing distal pulses also by the way. Every OB patient should have FHT obtained, and any woman laboring should have them performed before during and after to assess for fetal decelerations. True there isn't a whole lot we can do for the patient but what it can help you decide is the destination. If there are no decel's im more then happy to transport an hour + where the OB docs are and deliver en route, If the child is decelerating i'm going to the closest ER possible and let the higher trained deal with it.
DrankTheKoolaid
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Every child's heart tones are going to be found in different places. Best thing you can do is ask the expectant mother where they last found the child's heart tones and start there. As your searching using your other hand keep it on the mothers radial pulse to help differentiate her pulse from the baby's. And dont think you have to keep the probe perpendicular to the abdomen, some times you have to hit weird angles with it to obtain the FHT's
Every child's heart tones are going to be found in different places. Best thing you can do is ask the expectant mother where they last found the child's heart tones and start there. As your searching using your other hand keep it on the mothers radial pulse to help differentiate her pulse from the baby's. And dont think you have to keep the probe perpendicular to the abdomen, some times you have to hit weird angles with it to obtain the FHT's
8jimi8
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good idea to look up leopold's maneuver, to give you a better idea where to look.
DrankTheKoolaid
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OB wise only meds we carry are Pit and Mag other then that it's fluid bolus to slow contractions if an early unexpected labor. If the patient is term then i let them labor. And by saying hour i was being kind. Some areas of my response area i am with patients 2+ hours
OB wise only meds we carry are Pit and Mag other then that it's fluid bolus to slow contractions if an early unexpected labor. If the patient is term then i let them labor. And by saying hour i was being kind. Some areas of my response area i am with patients 2+ hours
WuLabsWuTecH
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Woooooah there!
Nobody who's in labor is going an hour away! We're not delivering in the truck if we can help it! I like to keep my net live patients at 0 -- number of live patients going in = number of live patients going out!
Why would you transport an hour away?
Also, besides your transport decision, what else are you going to do after you know what the fetal heart rate is?
DrankTheKoolaid
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FHT will only assist with destination decision. Other then that not much. And the reason we would transfer an hour is we are in a very rural area. Just one of the risks of living where everyone comes to vacation. Just because somebody is in labor does not make them unstable or an emergency. When you start talking grand maltips and vbac that's a different story. but in all likely hood there still going over the hill to where their OB docs are and where they are set up to deliver. The local community hospital stopped doing OB long ago and all OB patients are warned not to go there. If they do show up in the small community hospital to deliver, it will be an ER birth with no family allowed . Not exactly what they want.
FHT will only assist with destination decision. Other then that not much. And the reason we would transfer an hour is we are in a very rural area. Just one of the risks of living where everyone comes to vacation. Just because somebody is in labor does not make them unstable or an emergency. When you start talking grand maltips and vbac that's a different story. but in all likely hood there still going over the hill to where their OB docs are and where they are set up to deliver. The local community hospital stopped doing OB long ago and all OB patients are warned not to go there. If they do show up in the small community hospital to deliver, it will be an ER birth with no family allowed . Not exactly what they want.
Our maternal teams transport very long distances also to but do not use a buckshot way of determining destination.
If these transports are common for that facility it may be time for them to invest in a real fetal monitor for continuous monitoring during transport and train a couple of RNs for High Risk OB transport. Your doppler is not going to catch a decel when it happens if you are only assessing every 15 or 30 minutes. I would definitely advise staff at the hospital and you to take the High Risk OB transport course that is offered throughout the country periodically. This system your facility is transporting by sounds rather poorly thoughtout, haphazard and irresponsible to put a pregnant woman on a truck and just allow you to determine the destination. Not all EDs or hospitals are well prepared to do a crash C-section. When it does happen, the outcome may be very bad for mother and/or baby. I've done a few transports from local little EDs where this has occured and it is usually a very sad shift.
Also, if that mother delivers in your truck, you may have two very sick patients on board, the mother and the baby. If you are transporting patients that you may have to divert for, you had better be prepared to the worst.
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So what are you going to do, leave them at home?????
Maternal patients need to be where their OB is unless compromised hemodynamics necessitate a closer transport. That may be 10 minutes away, it may be an hour. Its not about your preference in patient numbers and you don't get to pick and choose your patient types. If nature takes course and she delivers, you catch and treat as needed.
I don't know what the issue is with people and delivering babies?!?!?!?!?
Ridryder911
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I guarantee, even in Ohio there are OB transports that are > 1 hr as I know of some services that even fly that long with OB patients.
It is not unusual as most hopsitals are not prepared for high risk or non-prenatal care.
R/r 911
medic417
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In 90% of cases it is no big deal. I've delivered a bunch in the ambulance. Yes it suc$ when you get one of the bad ones, but you do what you can for mother and baby and go on down the road.
The worst part of most deliveries is if the water breaks in the ambulance and you had failed to be prepared then you end up with slick slime to slide around on in the ambulance.
A point to discuss with your service is have more than 1 OB kit on board and keep lots of towels. Both can be used for more than OB's but you do not want to be short when it does happen.
There is no issue delivering babies. Our BLS trucks move expectant mothers from point A to point B if it is just to get the mother to a delivery room. Well babies during uncomplicated deliveries deliver themselves whether the mother wants to or not.
But if he is doing long transports lasting over 2 hours with mothers to be who are high risk and require fetal monitoring, that is a whole other issue. As well, an experienced OB nurse would be able to monitor decels and know which ones require intervention and which ones can be alleviated without looking for the nearest little general to pull into that hasn't even seen a baby in their ED not to mention a pregnant woman about to deliver. You can also bet if an OB team is flying for one hour, they know their destination hospital and probably won't park in a cow pasture looking for an ED.
You shouldn't have to play roulette with a baby or a mother's life. "Do what you can" is not acceptable even in the most remote parts of the country when it comes to specialty teams being available. Thus the reason why the OB transport association is making an effot to educate providers. Even for Peds, there is a network that can get a Specialty team to almost every part of this country to ensure safer transport.
We fly pregnant women from the islands and distant parts of nowhere in the U.S. quite often and I will gladly give up my Paramedic seat to the OB team for the mother's safety as well as that of the baby. No ego problem here. Yes, as an RRT I can do some fantastic things for a neonate but I also know my limitations. That has come with education and experience to where any cockiness is long gone.
Also, if delivery is imminent within an hour or less than the length of the transport, a controlled delivery should be done at the sending hospital.
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DrankTheKoolaid
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Vent isn't that why we become Paramedics, to take care of sick people? Mother and baby's included. What was the point of PALS and NRP if your so reliant on high tech garb and specialty teams that you cant' do it yourself.
You seem to think im working for a hospital based ambulance service. I am not. I am a 911 Paramedic and regardless of what the local podunk hospital is trained to do, when i am out in the hills somewhere, i could care less what maternal teams are trained to do as it doesn't help me a bit.
Vent isn't that why we become Paramedics, to take care of sick people? Mother and baby's included. What was the point of PALS and NRP if your so reliant on high tech garb and specialty teams that you cant' do it yourself.
You seem to think im working for a hospital based ambulance service. I am not. I am a 911 Paramedic and regardless of what the local podunk hospital is trained to do, when i am out in the hills somewhere, i could care less what maternal teams are trained to do as it doesn't help me a bit.
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DrankTheKoolaid
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Thats so very true and we do carry 2 OB kits
Vent No i am not an OB doc and sure i would love to have specialty teams available for all this stuff, but the fact is the Paramedics here ARE the specialty teams regardless if we want to be put in that position or not. And yes i hope i never have to deal with a very sick mother or child. Dont take this as what you call cockiness, this is my self confidence that i can do what i have learned and trained for should the need arise. Sure is alot better then not having the confidence in yourself to the point you are NOT able to perform it, and then what do you have? A provider not worth his hourly wage that does nobody any good.
Thats so very true and we do carry 2 OB kits
Vent No i am not an OB doc and sure i would love to have specialty teams available for all this stuff, but the fact is the Paramedics here ARE the specialty teams regardless if we want to be put in that position or not. And yes i hope i never have to deal with a very sick mother or child. Dont take this as what you call cockiness, this is my self confidence that i can do what i have learned and trained for should the need arise. Sure is alot better then not having the confidence in yourself to the point you are NOT able to perform it, and then what do you have? A provider not worth his hourly wage that does nobody any good.
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Well this post has summed up what I thought when I read your other posts. It does show that you don't have a good understanding of high risk OB especially if you believe PALS or NRP prepares you for any high risk situation. They are mere overviews and go very little into a high risk crisis on a long transport. I really advise you to take a high risk OB transport class to see what you are missing. At the very least take a fetal heart monitoring class at a hospital that does high risk monitoring. Please, please do not rely on PALS as your only training for this situation. Paramedics are trained for emergencies but very little for the OB type for long distance transports lasting over 2 hours. Even if you never have to use the information you get in one of the classes I mentioned, and I hope you never do, you may have a better understanding of the patients, including the baby, that our are transporting. A baby's life is too fragile and one shouldn't just pull the "I'm a Paramedic" attitude and believe you can do it all. Again, PALS and NRP do NOT prepare you for high risk OB.
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