Fetal heart monitors?

[DrankTheKoolaid]

re

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.

Vent having worked in the hospital setting that delivered babies for 10 years im pretty aware of High risk OB. My point being is that we do the best we can, with the materials we have to work with. This is a VERY economically repressed area that i am working in. Sure i could take a FHM class, but it wont change the fact that our unit's do not carry full time FHM's nor can we afford to if we wanted to. Thats why we use the portable doppler's we carry, it's not perfect but it is the best we have available to us.

And since you havent brought up HEMS yet I will. When we call for a HEMS to respond it's a crap shoot on if we get a side loader or a rear loader. Im not going to waste time on scene only to find out that once HEMS gets there it's a rear loading unit that im not going to put an OB patient into.

 

[VentMedic]

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.

I think you are confusing confidence with not knowing what you don't know and that gives you a feeling of that is all there is too it. Sorry but California does have a decent perinatal outreach/transport program for all parts of the State. I emailed a link to this thread to the Physician at Stanford who is the medical director for the state's Northern program. If he PMs you I hope you will provide him with all he needs to know about this hospital so they can set up an educational program for their staff and you as well. If you are not in the Northern region he can help you find out which one you are located in.

Again, please take the opportunity to educate yourself further and do not think PALS has taught you everything. You are not in the field but are doing a "Specialty" IFT transport which means you should have training for that specialty. I know in California that is difficult especially since your scope of practice is rather limited but you still should have the education even if you can not do the skills or all the meds/drips.

Vent having worked in the hospital setting that delivered babies for 10 years im pretty aware of High risk OB. My point being is that we do the best we can, with the materials we have to work with. This is a VERY economically repressed area that i am working in. Sure i could take a FHM class, but it wont change the fact that our unit's do not carry full time FHM's nor can we afford to if we wanted to. Thats why we use the portable doppler's we carry, it's not perfect but it is the best we have available to us.

And since you havent brought up HEMS yet I will. When we call for a HEMS to respond it's a crap shoot on if we get a side loader or a rear loader. Im not going to waste time on scene only to find out that once HEMS gets there it's a rear loading unit that im not going to put an OB patient into.

You can address all of your concerns with this physician and hopefully he can make some changes happen. These are all important issues that MUST be addressed for the safety of the patients in your area.

 

[medic417]

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.

I think you misunderstand my point of do what we can. In some cases we may be able to nothing more than slide our hand into the vagina and form a v and suction and ride the hour plus to the hospital in that position.

Or we may have to do something as simple as remove the cord from around the neck during delivery with no other complications.

Or cover the obviously dead stillborn with skin sloughing and while also handling medical try and give emotional support.

If premature perhaps based on what the exam reveals we may try and stop the contractions.

So no I am not advocating doing nothing. With education you will do what you can do with the limited resources available. Some OB's need definitive care which could be a simple as a c-section to major surgery to try and control bleeding.

Of course maybe we could do c-sections in the field. Seems there was... oh never mind that was our favorite bad portrayal of ems Saved.

 

[DrankTheKoolaid]

I think you are confusing confidence with not knowing what you don't know and that gives you a feeling of that is all there is too it. Sorry but California does have a decent perinatal outreach/transport program for all parts of the State. I emailed a link to this thread to the Physician at Stanford who is the medical director for the state's Northern program. If he PMs you I hope you will provide him with all he needs to know about this hospital so they can set up an educational program for their staff and you as well. If you are not in the Northern region he can help you find out which one you are located in.

Again, please take the opportunity to educate yourself further and do not think PALS has taught you everything. You are not in the field but are doing a "Specialty" IFT transport which means you should have training for that specialty. I know in California that is difficult especially since your scope of practice is rather limited but you still should have the education even if you can not do the skills or all the meds/drips.

Vent I'm not sure what your talking about in this line here. What i have been talking about all along is 911 response in regards to OB's in the rural setting.

Never did I mention anything about IFT's, which are handled in completely separate way

 

[VentMedic]

Vent I'm not sure what your talking about in this line here. What i have been talking about all along is 911 response in regards to OB's in the rural setting.

Never did I mention anything about IFT's, which are handled in completely separate way

You used the word transfer a couple of times in your posts.

And the reason we would transfer an hour is we are in a very rural area.

Either way, when the physician contacts you, he might be about to hook you up with some extra training and you can still express your concerns about the helicopter if you find inadequacies with it.

 

[DrankTheKoolaid]

You used the word transfer a couple of times in your posts.



Either way, when the physician contacts you, he might be about to hook you up with some extra training and you can still express your concerns about the helicopter if you find inadequacies with it.

Ah i had to scan what you read. Transfer = transport to me, unless i specify it as an IFT

 

[WuLabsWuTecH]

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?!?!?!?!?

No, we're not leaving at home, but we're not going that far either. It's not an emegency, we won't even go lights an sirens unless its a breech or limb presentation or if there is placent previa or placenta abruptia suspected.

Any doctor, can deliver a baby better than I can. I had maybe an hour of training on the subject. At the very least, they had 6 weeks on delivering babies.

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.

I didn't realize you only had one hospital with no OB unit!

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

Oh there are, the southeastern part ofthe state has practicaly no hospitals! But in my area, even if you're OB is at a hospital in an adjacent county, we're not taking ourselves out of service for that long just to get you to your OB when we'll have passed 4 hospitals on the way there that all have OB units.

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.

I think vent is trying to say that there are better equipped teams out there and when they are available you should use them. And if they are not, you shuold think about getting them b/c they are so much better equiped!

 

[VentMedic]

Ah i had to scan what you read. Transfer = transport to me, unless i specify it as an IFT

You should have put a disclaimer in earlier.

I think vent is trying to say that there are better equipped teams out there and when they are available you should use them. And if they are not, you shuold think about getting them b/c they are so much better equiped!

Even if one is a Paramedic, that also doesn't mean one can't learn a few more things. Recognizing the many anomalies in the neonatal world is a plus. Even those that affect just the airway can be pretty amazing and waiting until you see one is not the time to start learning. By the time you surf up the info on your internet phone, the baby will be anoxic. As I said in my PM to you, in the field and on maternal transports I have seen many of the bad things that can go wrong with nature at least twice. Granted I did a high call volume and many of my patients were without prenatal care as well as poor. It doesn't mean you won't see some of these things in California. Believe me there is a lot more to learn then just PALS and NRP when it comes to neonates and I can't even begin to list the maternal issues that can also go wrong. As Medic417 stated, over 90% will have no problem but the 2 - 10% that present with difficulties can make or break your day.

If you know you are going to be in certain situations, you might as well be as prepared as possible as least with education so you can quickly recognize what can be done or should be done. If I was to move to the wilderness, you bet I would learn a little bit about the animals and plants or whatever I would come across so I could treat my patients better.

 

[DrankTheKoolaid]

re

WuLabsWuTecH your absolutely right there are better equipped teams to deal with these things. But until they start answering 911 calls and going to these peoples homes when they call we are the best they have. And i would rather have them call us, then risk transporting themselves POV and delivering in the backseat of there vehicle literally in the middle of nowhere with no help what so ever. No were not trained anywhere near as much as a physician or a NICU nurse, not even close. But at least we are trained in the basics and can initiate advanced life support as needed on both mom and baby, if that need arises.

Not to mention during the winter months some of the mountain passes are undrivable or worse impassible because some big rig decides he doesn't need to chain up before going over the summit in between my area and the larger community with the 2 lvl 2 hospitals and wrecks completely blocking the 1 route we have to the larger community, sometimes for many many hours depending on how many other accidents the first causes.

 

[DrankTheKoolaid]

re

You should have put a disclaimer in earlier.



Even if one is a Paramedic, that also doesn't mean one can't learn a few more things. Recognizing the many anomalies in the neonatal world is a plus. Even those that affect just the airway can be pretty amazing and waiting until you see one is not the time to start learning. By the time you surf up the info on your internet phone, the baby will be anoxic. As I said in my PM to you, in the field and on maternal transports I have seen many of the bad things that can go wrong with nature at least twice. Granted I did a high call volume and may of my patients were without prenatal care as well as poor. It doesn't mean you won't see some of these things in California. Believe me there is a lot more to learn then just PALS and NRP when it comes to neonates and I can't even begin to list the maternal issues that can also go wrong. As Medic417 stated, over 90% will have no problem but the 2 - 10% that present with difficulties can make or break your day.

If you know you are going to be in certain situations, you might as well be as prepared as possible as least with education so you can quickly recognize what can be done or should be done. If I was to move to the wilderness, you bet I would learn a little bit about the animals and plants or whatever I would come across so I could treat my patients better.

Lol, Vent you just described our patient populous to a T where I'm at in California. And your right, more education on the little known/encountered subjects is always a great idea, which i don't believe was ever a topic of discussion here as we all know that anyways.

 

[VentMedic]

, which i don't believe was ever a topic of discussion here as we all know that anyways.

We just had a neonatal discussion over the past few days started by Sasha with an article about how little education and training those in EMS get for neonates.

 

[DrankTheKoolaid]

re

lol, i meant in this post. Yeah i read and posted in the other post your referring to.

 

[VFFforpeople]

Putting this out there..but why are we trying to diagnose the fetus? I am mom is alive Rapid transport..mom is dead rapid transport. We can't save them in the field, so it is kinda pointless. Just my opinion on it.

 

[medic417]

Putting this out there..but why are we trying to diagnose the fetus? I am mom is alive Rapid transport..mom is dead rapid transport. We can't save them in the field, so it is kinda pointless. Just my opinion on it.

And another reason EMS is just considered a taxi service rather than a medical profession is people with your attitude.

 

[VentMedic]

Putting this out there..but why are we trying to diagnose the fetus? I am mom is alive Rapid transport..mom is dead rapid transport. We can't save them in the field, so it is kinda pointless. Just my opinion on it.

He's got 2 hours with mom and baby. It would be nice if at least one survived. With 2 hours of travel time, you can not rely on just how fast your ambulance will go. You have to have some smarts also.

 

[Sasha]

We can't save them in the field, so it is kinda pointless.

Isn't the whole point of EMS to assess the patient and initiate potentially life saving interventions pre-hospitally? If not, what is the point of an ambulance? Why not just have everyone bring people in by POV?

 

[Flight-LP]

Isn't the whole point of EMS to assess the patient and initiate potentially life saving interventions pre-hospitally? If not, what is the point of an ambulance? Why not just have everyone bring people in by POV?

You may have a good point there Sasha. Considering some of the crappy attitudes here about maternal patients, they may be better off! Folks, these patients need their OB, not some doc in the box ER. I would be one pi$$ed off patient if I was billed for using someones services I didn't want. You will take me to my doctor, again unless my stability dictates otherwise. Outside of that, I will go POV. Fortunately, many OB patients are specifically advised NOT to call for an ambulance if at possible to avoid some medic deciding what he/she thinks the patient needs instead of listening to what they actually do need.

PALS is irrelevant in Neonates and NRP barely scratches the surface. S.T.A.B.L.E. is about the closest Paramedic's have to actually learning about treating this unique patient population.

Just like all other patients you come in contact with, if you have to run to the closest ER and use diesel therapy as part of your care plan, then you need to re-evaluate you capabilities and adjust them to adequately treat your patients.................