OB's - Paramedics Checking Dilation

[spenac]

where your standard urban cookbook won't get you past the first ten minutes of three hours of patient care. And I find it a little amusing that many of the same people who always whine about limited protocols, limited, pay, and limited respect will turn around and try to draw concrete boundaries around our practices.

HAHA. Dust you hit it on the head. As you have seen many of my posts get people uncomfortable. I have gotten nasty comments on some topics. All because I try and get people to get out of the hospital is 5 minutes away so load and go mentality. In a perfect world we would all be given much more education including how to do many skills currently not done or only done in limited areas. Then medical directors could allow us to do more to the benefit of the patients.

Pre-mature labor is when more is needed. On full term the only real work is the clean up 90%+ of the time. To have more info allows as you said to get everybody geared up or to realize lets just take our time with a smooth ride.

I do realize I am in a semi unique environment as Dust is aware. We have lots of uneducated, poverty stricken, and often illegal patients that are to scared to get help until it's to late. Thats when we are called and we not doctors make the difference. As we have basically no communication with hospital until we are about 10 miles out. Even satellite phones in this area don't work well because of all the mountains and canyons.

Now don't get me wrong just like everyone else most calls are BS and the only impact we are having is saving the person gas money to the hospital as they're not going to pay for the transport. But when it's real it's me and my partner and no one else. Thats why I say expand our education which in turn will expand our scope of practice. We are practicing frontier medicine. We do treat and release, we deny transports, we, well you get the picture we are allowed to practice medicine, thanks to an awesome medical director.

[TheWritingParamedic]

Not always true. In seriously premature labour, this information can be invaluable to the crew and the receiving facility in deciding what to prepare for, and the possibility of diversion. When you have over an hour of transport, things can and do change very rapidly. Labour-like pains in a preemie mom that is not dialating is a very comforting thing that will allow you to transport without panic, and the hospital to wait without panic. Labour pains in a preemie mom who is rapidly dilating is extremely worrisome. You are going to want to have your ducks in a row, and so is the receiving facility. After a one to two hour transport in labour is not when you want your very first eval done! Especially on these young moms with zero prenatal care and a very limited ability to relate their prenatal history because they speak no English.

Think outside of the box, people. Not every EMS system is like Turd Watch, with cookbook medics working 5 minutes from three different Level 1 hospitals. There are some extremely remote and unique systems out here -- including mine -- where your standard urban cookbook won't get you past the first ten minutes of three hours of patient care. And I find it a little amusing that many of the same people who always whine about limited protocols, limited, pay, and limited respect will turn around and try to draw concrete boundaries around our practices.

Yes, I can see where you are coming from. However, despite all that I still don't believe it is appropriate to check for dilation in a prehospital setting unless you have a delayed/long transport time. Maybe there are other reasons as well as to why someone would like to check for dilation, but... in intercity EMS, it's not really something we should put into practice. But I can completely understand what you are saying.

[whit72]

99.9% of deliveries are BLS, whether your ten minutes out or 3 hours. If your delivering ten kids a year in the field then I believe you may have the oppurtunity to experience more abnormal births and further education is probably needed.

If Im thee hours out and I discover a limb pertruding, guess what I am doing? Calling the bird. I am not dicking around with a high risk delivery for three hours that I might end up elbow deep in, when we can fly her there in a half hour.

[spenac]

99.9% of deliveries are BLS, whether your ten minutes out or 3 hours. If your delivering ten kids a year in the field then I believe you may have the oppurtunity to experience more abnormal births and further education is probably needed.

If Im thee hours out and I discover a limb pertruding, guess what I am doing? Calling the bird. I am not dicking around with a high risk delivery for three hours that I might end up elbow deep in, when we can fly her there in a half hour.

Haha If only, definitely big city thinking. There is no bird that comes to my area. They meet us at the hospital or the airport just across from the hospital if fixed wing. Like I said earlier it's just me and my partner. Also in my limited experience with calling the bird, OB's often are not allowed do to limited work space. Most of the ones that we have that get transferred out they send a speciality ground ambulance from the nearest big city which is 2.5 hours north of our bandaid hospital. But maybe thats just our so called "local" birds protocol.

[captainstandup]

I agree with several others that checking for dilation is unnecessary in the field. Visual inspection and frequent reassessment of a patient with impending delivery is indicated. I agree with Rid that this "skill" would be fraught with error and I just don't see where it would be helpful. In treating OB patients with potential for field delivery we are going to break out the OB kit (God Forbid!), increase the temp in the unit to match that of hell's front porch and simply take care of mom while frequently reassessing. Man I hate OB Calls...................................

[Dustdevil]

I agree with several others that checking for dilation is unnecessary in the field.

Never? Ever? You completely lack any ability to ever envision a medical need for this in the field?

I agree with Rid that this "skill" would be fraught with error and I just don't see where it would be helpful.

I don't think you understood what Rid was saying.

I agree with Spenac. A lot of people here seem to have no significant OB knowledge experience at all. And definitely no rural experience.

[katbemeEMT-B]

[quote="Dustdevil

I agree with Spenac. A lot of people here seem to have no significant OB knowledge experience at all. And definitely no rural experience.

[tniuqs]

In addition:

OR very Remote .

[tniuqs]

One that jumps to mind that can be missed even by an OB, placenta previa. If an untrained person decides they need to check to see how far dilated mom is not realizing the placenta positioned over the cervix, they will cause a puncture, which in turn will cause mom to bleed out, resulting in death of baby and mom if definitive care is not close by.

Interesting PP missed by an OB.... they do routine Ultrasounds. I really have a hard time swallowing that one, C sections are the bread and butter of OB specalists.... SO if the Mom has a low implanted Placenta (unrecognised or undiagnosed)and infringing upon internal oz then during a normal progression of labour. The mom and child are both in a life threatning situation.... any dilation of will result in serious bleeding, AND prior to any rupture of membranes, seriously if one is doing a pelvic with this amount of force.....and lack of knowledge I must agree they should NOT be even attempting to judge station or cervical dilation, bottom line education is the key.

Fortunately, it sounds like the inexperience is in close proximity to a hospital.

Could you explain this statement, I don't think I understand just what you are saying?

cheers

[captainstandup]

Perhaps I did misunderstand Rid. In any event I never say never but I admit you could have derived that from my post. I must ask though, what useful information can you gain from checking for dilation in the field that will affect or change your care of the patient? I mean information that is totally different from that gained from visual inspection.

I have crunched this for several minutes and the only thing I come up with is a better estimate of where the patient is in the delivery process (time to delivery). Does this determine whether you stay on-scene or drive with reckless abandon? I noted in my earlier post that we would make appropriate preparations for delivery. I am trying to learn something here so skip all the personal attacks and help me understand the benefit that outweighs the risks of doing this in the field.