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Handling a maternal cardiac arrest situation-rural EMS


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I assume that by, "out of our scope", you specifically mean your own scope. Because the fact stands that it is not outside the scope of thousands of medics in this country.

C-section = hard

Cutting baby out of dead body = not hard. Especially if you have a professional education in gross anatomy, and not just that little bit they give you in the average paramedic class. Combine that with having actually paid attention and participated in OB rotations, as well as the real-time advice of a physician on-line, and it is not hard at all. Once you've seen those structures for yourself, in real life, they are not at all difficult to identify and dissect. But yeah, if all you have is those few hours of looking at drawings in a paramedic book, your confidence level will understandably be nil. However, believe it or not, some paramedic schools actually provide a good educational experience.

Unfortunately, the majority of the medics in this country graduate having never even intubated a real person, much less an adequate anatomy education or sufficient amount of clinical time. But don't project your lack of education and confidence on the rest of the nation. We already have enough problems with the firemonkeys doing that.

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Somehow I doubt the instructors are thinking the student will be slicing a pregnant woman from xyphoid to pubis though. There is a big difference between trying to save a life and making an error com

Let me put it this way. There are dozens if not hundreds of very impressionable young medics out there who read our words and take our words of experienced knowledge to heart, as erroneous as some of

Well I got an unofficial opinion from someone with the Ontario base hospital group. I was essentially told that if the mom's obviously dead and hospital is close by, we can run the arrest into the hospital but otherwise no BHP in this province is going to approve this over patch.

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Dust,

While I appreciate the thinly veiled condescending attitude, I think you were better off with the "you just don't have enough guts" argument. You don't know me personally nor do you have any clue what kind of educational background I do or do not have. I have made no such assumptions about you, so I would appreciate it if the personal attacks stopped right there.

Maybe everyone is more intelligent and better educated in Texas. Who knows, right?

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The assumption came from your own facts. I think it is a fair assumption that, if you would not be comfortable with such a simple procedure, under the guidance of a physician, then your education was inadequate. Adequate educational exposure to anatomy and surgery would give you the insight to realise that it is very much within your capability.

Prove me wrong. How many c-sections did you closely observe in paramedic school? Was there a gross anatomy lab in your paramedic school?

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Prove me wrong. How many c-sections did you closely observe in paramedic school? Was there a gross anatomy lab in your paramedic school?

Seven, and I did the incision on the last one, yes we did have a GA lab as well as 5 visits to the pathology lab for hands on with the pathologist

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Seven, and I did the incision on the last one, yes we did have a GA lab as well as 5 visits to the pathology lab for hands on with the pathologist

Excellent. Are you saying that you would not feel capable of performing such a procedure on a dead body, with the step-by-step direction of a physician?

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Yup.

Again, are you actually saying you believe yourself incapable of competently performing the manoeuvre?

Or are you simply saying that you still would not do so, due to legal or philosophical concerns?

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If the lady is dead not like you can do any harm by trying. If you do nothing baby joins mother in death. Would my attempt be as neat and pretty as the docs? Probably not but I don't have to worry as she will not need her body anyway as she's dead. My job is to help the living and if the baby is alive in a dead mother I need to extricate the baby.

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Again, are you actually saying you believe yourself incapable of competently performing the manoeuvre?

Or are you simply saying that you still would not do so, due to legal or philosophical concerns?

Let me put it this way. There are dozens if not hundreds of very impressionable young medics out there who read our words and take our words of experienced knowledge to heart, as erroneous as some of it is. Something like this is not as clear cut as it seems, and the last thing I want to find out in the news is that a maternity patient had a bradycardic episode that became asystole, and rather than treating the mother, these impressionable rookies recalled our conversation and grabbed the scalpel instead of the atropine because they heard somewhere that some medics think it is best for the mother to be dissected to save the baby.

Now, to your question, do I feel competent to do it? Yes.

Would I do it? Perhaps under the following conditions.

I know exactly when the mother went into cardiac arrest,

I know I have the approval of the next of kin in writing,

I know that the mother has sustained injuries that will prevent her resuscitation of any sort,

I know that the mother is unable to be transported immediately with CPR enroute,

I know that my transport time will be a death sentence for this fetus

I know that the fetus is still viable

I know that my medical control is on board, and

I know that I am comfortable with the possibility that after this call I will never be permitted to perform even a blood pressure on a person ever again and that I will likely be spending the next 20 years in court defending my actions, and likely penniless because my malpractice insurance will not cover me for working outside my scope of practice, regardless if the child lived or died. BTW, the 20 years? Not an exaggeration. The child will also have the right to sue me once he turns 18.

There is the reality of it, If all those conditions were met, I would be happy in knowing that this child was actually around to sue me, even if he is trying to ruin my life for saving his.

The fact that the mother is dead is irrelevant to the situation. If we had nothing in our arsenal and training to reverse this condition, then it might. The fact that we can actually reverse death means that the adage "She's dead, so it doesn't matter what you do it can't get any worse." is not applicable. First, we have to ensure that we tried to fix a fixable condition, otherwise why bother taking ACLS training? It's not over for our patient when our patient is dead, regardless how pregnant she may be otherwise we might as well just start using every code patient we treat for cadaver training instead. Even a patient with a head crushed to 3 inches thick may have enough lower brainstem function to be able to maintain adequate perfusion to the fetus until such time as it can properly be extracted.

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