Is childbirth an ALS or BLS call?

[DrParasite]

ok, here's the situation. yesterday morning, ardoun 5:40am, my BLS crew were dispatch to transport a pregnany lady to the hospital. contractions were 5 minutes apart. this was her first kid too. anyway, ALS was not dispatched due to the fact that no one expected her to deliever the kid (which she promptly did in the back of the ambulance, ew, lots of blood, icky).

anyway, dispatch dispatch called to say no medics were sent because she wasn't expected to deliver (she was also 8 months along). My response was that childbirth (without complications) is a BLS skill, so why are medics needed? I can understand if there are complications, but a simple thing that women have been doing for thousands of years? it is also taught in the EMT-Basic class, and the main thing is that women are actually doing all the hard word, we are just helping out. one of the people on my squad said to get medics, because they might start an IV in her. but it's a BLS skill, right?

So that's my question. can a childbirth call be handled by an EMT-B, or should ALS be called?

[Weruj1]

Dan,
I voted for BLS as that is the skill level you are operating as and I agree with the things you mentioned as well. MOST care provided in an uncomplicated childbirth is supportive, (oxygen, IV @ tko for fluids or pain mgmnt). The only true thing that a medic could do is suction meconium from the newborn and place an ET tube if neccessary, and give any meds. Also most new mothers are in labor for 24 hours or so. As you found out it is manageable at the BLS unless you have any complications then you must decide to call for ALS or rapid transport.

[DaSharkie]

BLS. All I MAY do is drop a line. If the mother or the patient crumps that is a different story, BUT THE INCIDENCE OF SUCH IS REDICULOUSLY LOW.

The post is correct, Basics are just as trained in childbirth as a Paramedic. I have had no further training as a Paramedic than what I received in EMT class. I did have to spend 24 horrific hours (OB is not my thing) in the OB ward but all I did was observe births, not participate.

[IAMedic]

As long as there isn't any breathing problems then it is a BLS call. Women have been having children a lot longer than EMS has been around. I have the pleasure of working in the Respiratory Therapy dept at hospital-based service & help with natural and surgical births and can count only a couple times where advanced skills were needed. But, we knew in advance that there was going to be a need for them. Whether it was meconium staining or premature births. I voted BLS.

[WTFD10]

I vote for ALS. Yes, it is a BLS skill but I will always feel more comfortable with a Medic there in case of complications, rare though they may be.

[SafetyPro]

I'd say BLS as well, unless you know at the time of dispatch that there are complications, in which case ALS is probably justified as a precaution.

We've delivered several babies in the history of our department (most recent was about 2 years ago) and we're BLS.

OF course, during my wife's recent pregnancy, I kept suggesting that I just deliver the baby myself, but she didn't like that idea. :D

[Scotttt]

i think it depends on the depth of the basic training. i, as a basic do not feel that i received adequate training in child birth. i believe it was covered in one class and we maybe watched a video of a birth. no practice on a dummy or practical of any kind. so if this is the extent of training for basics, als should be on scene.

in reality, it is a BLS skill if the basic has had proper training.

[latigo]

I don't mean to come down hard on you, but if you don't feel comfortable with the skills you were taught, you need to go out and get a refresher. That can be as simple as con ed during meeting night up to going to your med director and requesting more training, be that time in an OB ward, a formal class, auditing another class, or whatever. It is a situation you might come up with practicing at a basic level, and there may not be any ALS units available. You might run into it tonight. So, go get some more training so you will feel comfortable. With no complications, it is a BLS skill. I can't see pulling an ALS rig off of a CP call to come stand by for a simple birth.

[42VTExplorer]

Not to nitpick but...

FRs are also trained for child birth...


So that's my question. can a childbirth call be handled by an EMT-B, or should ALS be called?

Up until quite recently all "field births" were handled by EMT-Is and diesel. FRs have handled it too in regions where an ambulance is 30+ minutes out.

is suction meconium from the newborn

In FR class we were told/shown in our slide show, and in book about how to suction a newborn. What's the difference between a Medic and a FR doing this skill? Nothing. A medic may be able to intervene (sp?) at a later time iwth ALS 1/2 care, but when strictly BLS a FR is just as capable in my mind.

I'm not trying to play the <b> "Super Uber God PersonThat Just Got The NREMT First Responder Certification And Have Been On The Streets For A Week"</b> Position, but if we're going to maintain the patient(s) at a BLS level, why not try to include your FRs if they are there?

I realize that as a FR I can't give O2 without the added Oxygen module, etc, but aren't we just as capable BLS providers?

***NOTE:
I'm still in class, am not a FR yet. I don't get my actual card till early November. I also don't want to come across as a certified person by any means. I'm uncertified, very untrained (getting my feet wet with FR after 2 years of being a third rider with EMS, roughly 1 year with Fire). I <b> KNOW </b> that as a FR I cannot handle a call alone, know that I do need assistance, and I know that I won't be leaving my scope of care behind.

Oh, and GOOD MORNING! :D

[Scotttt]

i do think, givin the situation, i could handle it. i remember what i was taught fairly well. but regardless what i remember from text and lecture doesnt translate well to proficiency in action.

the basic doesnt receive indepth OB training like that of medics. so if i go to my medical director and state i want additional training, sure thatll do me good, but what about the hundreds of other basics who have had the same inadequate training. overall other basics could handle it and things would turn out fine. but regardless i feel its something that should be practiced more indepth for the basic. and if put in the situation of imminent birth, i'd much prefer having a medic by my side, i f he wants to release newborn and mother to BLS afterwards, fine.

i dont know maybe this inadequacy is relative to my area or the institution through which i was trained.

anyhow, a month from now my class will be studying ob/gyn emergencies. so my adequate training is coming.

[Medic162]

Originally posted by DaSharkie
I did have to spend 24 horrific hours (OB is not my thing)

My sentiments exactly!!! I consider childbirth a "BLS" level skill as well. Especially since I'm on an ALS unit:D As several others have stated, we medics only bring in the heavy guns on a "bad" birth, and even then we're quite limited except in the case of cardiac or respiratory problems. In 99.9% of field births, any good EMT-B should do fine.

[Weruj1]

.......In FR class we were told/shown in our slide show, and in book about how to suction a newborn. What's the difference between a Medic and a FR doing this skill? Nothing

42VT.............with all due respect ........you are not, and will not be trained to place an ET tube in a newborn, with a meconimum aspirator attached, and suction WITHOUT being a medic.......it is WAY different than suctoning an adult.....oh ya you can use a bulb syringe.............do you even know what meconium is there almost a FR ?

[ff7134]

Its BLS....and I have informed he guys on my crew of this. So unless all @#$% breaks loose...they are in the back for these calls. I have came close 2 times and thats 2 times too many if you ask me.

[tanker5117]

I voted BLS also. I am only a FR, waiting to start my EMT-B class. The one incident I was on, the cops (FR certified) already had the baby delivered (in the back of a taxi) by the time we got on scene. I crawled into the back of the taxi with the birthing kit, clamped the cord, suctioned and wrapped the baby and started getting vitals on mom. The medics showed up at that point, got set up in our rig. we got mom and baby out of the taxi and into our rig. Medics evaluated both, we transported without incident to the ER. Medics later told me that they weren't really needed, that the cops and us FR's did ok. :D

Tanker

[kghemtp]

Joshie, the lad felt left out! He gets defensive & petty sometimes.

On the other hand, 42VT brings up a good point. I would recommend that any & all EMT's & first responders who can reasonably fit into an ambulance take part in the childbirth process. It provides a couple different things, such as exposure to this event, AND there are a few extra hands for getting different things accomplished enroute to the hospital or after. I will admit that not every situation is one for explanation or teaching AT THE TIME, but there is nothing like being part of a call rather than reading about in the Brady book.

I agree that BLS is adequate, but at the BLS level I would hope people are thinking about how far ALS is should this call turn to crap in a hurry.

So Josh & Sharkie & any other medics out there, did you have some of the great doctors in OB that said, "This is paramedic ______, and he could be called on for such an event. Would you mind if he observes?" Most of the time I went in with the nurse, explained who I was & asked if I could participate. As part of my OB time, I was fortunate to go out on a transport with a high-risk pregnancy, so I got out of the hospital for a bit.

[MARY016]

Definitly a bls call. I've had two live births and 1 stillbirth, If the case were to arise (which it won't) I'd still take a bls ambulance. There's not a whole lot anybody's gonna do in a short amount of time anyways.
Just two months ago, my FD was paged out for a pregnant woman with labor pains 10 min. apart. Being only one of five females in the dept. and 1 of 3 EMTs I was on the spot. Soon after we arrived, I figured it was a false alarm. NO pains for at least 15 more min. She still wants a ride to the hospital. And the ambulance pulls up with two male medics. Guess who gets to go the hospital? We went red lights and sirens even though she had no pains. Why?
I guess my whole point here is why not have a little trust in your EMTs?

[DaSharkie]

So Josh & Sharkie & any other medics out there, did you have some of the great doctors in OB that said, "This is paramedic ______, and he could be called on for such an event. Would you mind if he observes?"

A nurse did so. Sometimes though the nurses weren't the biggest fans of Paramedics (not trying to start a fight here) being the rooms to observe OB. A classmate of mine had a floor OB nurse tell him that there was no need for Paramedics to observe childbirths - and no she was not an older nurse.

This was at a particular hospital in Worcester too which tends to be fairly EMS friendly. It was a bit of a shocker.

As for me, most of the people were accepting of me being in there and one lady was cracking jokes with me.

[Weruj1]

I can only recall not being able to asses, view, etc on one patient ....she was really having a tough time with the pain and was on her bed on all fours facing backwards ..........other than that I did have a good OB clinical rotation.

[kghemtp]

Had a cool resident there one time on my rotation who wanted to know more about EMS & our role with all this. He asked if I was allowed to catch there at the hospital. I thought for a second, "if I say yes, he's gonna let me!!" :) I said that we're there primarily for observing, but when stuff happens I'm another set of hands in the room. It worked quite well, and I had fun.

I didn't find this was the kind of clinical that everyone was fighting over, like the need for OR/tubes, ER, and so forth. I found L&D was a lot like riding on a rural department -- an entire 16 hour shift can go by with nothing!

[42VTExplorer]

kghemtp,

I probably got a little too defensive, but I wasn't trying to come across as petty by any means. This morning when I wrote that post I read through it a few times, revised, and tried to make sure I wasn't going to come across as a "God Provider".

42VT.............with all due respect ........you are not, and will not be trained to place an ET tube in a newborn, with a meconimum aspirator attached, and suction WITHOUT being a medic.......it is WAY different than suctoning an adult.....
I never said I was trained at ET tube placement, nor did I say I would be as a FR. I wasn't aware that a "meconium aspirator" existed. I've never seen one, period.

The only true thing that a medic could do is suction meconium from the newborn and place an ET tube if neccessary, and give any meds.

That's what I originally quoted from you, no where did you say that you would have to use a meconium aspirator to suction. I was under the impression that you would use the bulb/other suction device as needed.

oh ya you can use a bulb syringe.............do you even know what meconium is there almost a FR ?

If I didn't think I atleast had *some* knowledge on this subject, I wouldn't have posted. Oh, and I do know what meconium is. Meconium is the newborns first stool / bowel movement.

[Resq14]

I like to think of it this way:

If it were my baby, I would want to have the best and most advanced care available... EVEN if it is not needed, or the statistics show 1:1,000,00 odds of there being a problem.

The numbers and protocols will say BLS.

When it's mine, I'll say ALS. Shrug. It's worth it to me, so I'd kinda think it's worth it to everyone else.

Oh yeah, don't forget the "rules":

Rule #1: If you drop the baby, pick it up.


Rule #2: Do not drop the baby.

;)

[DrParasite]

If it were my baby, I would want to have the best and most advanced care available... EVEN if it is not needed, or the statistics show 1:1,000,00 odds of there being a problem.
ResQ14, no offense, but if it's my baby, I would want a Senior OB/GYN with a midwife on scene delivering the baby.

and I would agree, those ob/gyn and pregnancy classes were torture. most guys were just praying they were be done so they would move on to something more pleasent... like an eviceration or a multi-system trauma or a GI bleed......

as for FRs doing childbirth, well, sure. if that's all you got, then yes FR can do it. They stabilize until the EMT or medic gets there. but the question was is a medic needed.

and yes, on this birth, we delivered on scene, and then went L&S to the hospital. the initial plan was to go cold, but after she delivered, we wanted to get there ASAP. we didn't go 90mph bouncing the guys in the back, but we made sure we got there as quickly and as safely as possible.

oh, and for those that say "ALS just in case something bad happens," just think about the next time you respond to a call for lacerated finger. you would want medics "just in case." or a sprained ankle. "just in case." Basics are capable provides, and shouldn't become "medic dependant" on non-ALS calls.

[DaSharkie]

If it were my baby, I would want to have the best and most advanced care available... EVEN if it is not needed, or the statistics show 1:1,000,000 odds of there being a problem.

I think the opposite, why tie up an ALS rig when someone else is going to potentially need it. When I did intercept work I would have turfed this right to my Basic partner or to the other squad. If you need me call, but there was no need for me there and I could be eavailable for other incidents.

[PrttyEMTB]

i got to do it my first day in ER clinicals.
This woman comes in obviously pregnant and says shes not, but she is having "labor-like" pains in abdom and back. so the student nurse orders pregnancy test andas soon as she says "its negative" the woman's water broke, all over my scrubs! ewww! the other nursing students were like i dont know what to do!! and i'm like umm.. guys.. ahh.... the baby is crowning... so they call ob down to the ER but it takes the ob nurse forever and the baby fell into my arms, i suctioned with a bulb syringe and clamped and cut the cord, i'm just lucky i read the chapter in my book beforehand coz i thought it was interesting, i have always wanted to be an ob doctor since i was a little girl so it was perfect for me, the ob nurse delivered the placenta, but i got lucky that day i was at the right place at the right time. it was very educational! so yes i think delivering a baby without complications is a bls skill!

[WTFD10]

Originally posted by DrParasite
oh, and for those that say "ALS just in case something bad happens," just think about the next time you respond to a call for lacerated finger. you would want medics "just in case." or a sprained ankle. "just in case." Basics are capable provides, and shouldn't become "medic dependant" on non-ALS calls.

That's an apples and oranges comparison. A newborn in distress or the mom hemorrhaging is not even close to a finger lac or a sprained ankle.

We're lucky in this area that we have multiple ALS transport units in close proximity as well as some Medics on our dept. I would much rather have them onscene or at least enroute then to have to special call them as the situation goes to s***. If all goes well with delivery I can always cancel them.

I can see how a rural area or a very busy area with limited or tied up ALS would look at this issue differently.

[ddman466]

here in ky. this is a bls level unless like what i have read here, is the same other places. i too am a fr and have been trained in the child birth. but as a precaution, i would have als on stand by. im sure the medics would agree that it is better to be called out and not needed as to be needed and not called. and mothers deliver babies,we dont. we are justthere in case something goes wrong. but how ever i do recall in the brady book the many bold type "do not pull on the baby", kind a makes you wander somewhere sometime someone has pulled on the baby.

[ABMedic]

Hey I agree that child birth rarely needs significant interventions, women have been dropping them for years - hmm but with training we certainly have seen the infant mortality rate in child birth drop.

It's my viewpoint it's better to have more training than not enough - thats why Advance Life Support Obstetrics (ALSO) course are being taught - not for the routine - but the holy " $#^@" cases that occasionally happens - our system mandates for delivery two ALS units - one for the mother the other for the neonate - if its a uncomplicated delivery everyone smiles and mom and baby go in one rig - if "$#^@" hits the fan - you have teams to address the problem -initiate neonate resuscitation triange upto and including intubation, epinephrine, and umbilical line.

Perhaps since in the past I worked in a Neonatal ICU my viewpoint is cautious - but at least have the resource if it's available attend the delivery - I have watched EMT's do the delivery while providing backup - just in case - unanticipated problems (that do sometimes occur)

What wrong with the picture of sending two EMS units to a delivery? Don't you have two potential patients? Everyday we send 6+ fire apparatus to every alarm - most of them false - but we can't send 2 rigs because???

ABMedic

[Resq14]

Originally posted by WTFD10


That's an apples and oranges comparison.

Thank you.

There's a hell of a lot more riding on a problem with a child birth than with a cut finger... come on. Get real.

Yeah I would want the best neonatal intensive care OB/GYN specialists available PREHOSPITALLY too... IF THEY RODE AROUND IN AMBOS! But they don't in my area, and the best I could hope for is a EMT-P. And that's what I'd want. Wouldn't you? JUST IN CASE? I think "just in case" is absolutely acceptable in these circumstances.

Again, I realize percentage wise that odds are in favor of smooth deliveries. I realize it's a natural process where mom often doesn't require any type of assistance from anyone else. And I support effective deployment of resources. But this is one I personally take exception to. If the 1:1,000,000 were mine, those of you here telling me "but most childbirths go smoothly"... heh.

Even with excellent prenatal care... I want the best care for "what ifs" in this case. If there are some of you out there who disagree, that's fine. I'm not arguing, just trying to understand.

The post title says "without complications"... how the heck do you know that until the baby is out and pink? Not all complications are obvious prior to delivery... :rolleyes: It's too little, too late when the complications develop to all of a sudden call for ALS.

IMHO, sent ALS early and often for child birth.

ABmedic, good points. I wholeheartedly agree.

[ALS142]

Basic childbirth is definitely a BLS skill. Ninety-plus percent of the worldwide human population is born outside of a hospital. There is no need for a paramedic to be on every childbirth call. It's great if they're there in case something bad occurs, but they are a fall-back.

Personally, I've delivered 23 babies in the field, including a set of twins under a helicopter in the middle of the desert (Saudi Arabia)in the past 27 years. Luckily, every one was straightforward and without complications. If I had my druthers, I'd rather not ever have to deliver another one again. I can understand EMT's wanting a medic on-scene for a childbirth, and I have yet to see one step forward and be willing to be the lead on this type of call.

[RoryEl]

I agree with ABMedic

[DrParasite]

in case anyone was wondering, I made the paper. here is the link:
http://www.thnt.com/thnt/story/0,21282,1037846,00.html

it's not apples and oranges (comparing to a minor call), because it's calling for ALS "just in case." you can say a cut finger might have internal bleeding. it's probably not going to happen, but "just in case."

I'm all for erring on the side of caution, but BLS can handle this type on their own. if their are any problems, they can always request ALS.

btw, the poll is 22 for BLS, 9 for ALS

[Resq14]

pffffft

It's fine til you're caught with your pants down.

Then, you're already behind the game.

If the resources are available, at least have them standby. I don't care if the als crew sits 200 feet down the road while the bls crew delivers for the "glory." That's fine. If the resource is available though, I say use it.

Culture, infant mortality, prenatal care... all kinds of things play into this discussion. To just give a blanket "women have been having babies forever" and "i've never had a problem" does nothing for me when it's my wife and child that might be in distress.

I guess that's why I can't figure out people who enjoy the nonmedical birth experience. Screw that imho. But, to each his/her own. I'm not going to force my views on anyone.

[ALS142]

When the ALS unit is tied up on an OB call, doing what a BLS crew should be doing, and they're needed for a call which is definitely ALS (trauma, MI, arrest), then you'll see the logic of appropriate care where needed.

[RoryEl]

There is more involved in the decision of who should attend a delivery then who's minimally qualified. If that were the case then RN and LVN would be the only professionals in L&D and OB docs would only deal with GYN. Why is obstetrics the disappearing specialty and malpractice insurance so hard to come by and afford? As a rule, the people we see deliver outside the hospital tend to be the higher risk population. All things considered, sending the least trained and least prepared may not be the best choice, esp. when looked at retrospectively when you’re on the record defending your decision.

PS: As a side note, I understand the mindset of "we may be needed on another call" and I have used that same argument myself, but am only able justify it empirically. I have never been able to justify that stance when I had the hard cold numbers at hand. Also, in a small system the allocation must be more stringent because the likelihood is higher, but it must be based upon facts (statistic) not whims, or hunches.

[PrttyEMTB]

ok I know it is a basic skill, and basically us basics can handle it, but I'm kinda going back on my words here, you want the best level of care for each and every patient, weather they are 90 years old or 90 seconds old. So If I were out with a bls crew I would call als, to assist, you can not be too careful, and so what if als wasnt needed, because what if they were?

[kghemtp]

Makes me think that EMT-B classes should do a little labor & delivery time as a good first exposure to such an event

[Scotttt]

yeah, maybe EMT-B's should, huh?

y'know, for something that is such a BLS skill. medic students sure do spend alot of time training for such a BLS call. i think my program will have us do 24 hours of time in L&D observing births. and i imagine we'll devote a few classes to the birthing process. somewhere someone feels that ALS providers should be better trained at a BLS skill than BLS providers.

[Resq14]

I think we're confusing things.

The actual birthing procedure is a basic skill... yes.

I'm more concerned about problems that develop once the baby is delivered. EMT-B's do not have the knowledge, skills, or abilities to handle many of these emergencies at the level of an EMT-P. Again, as rare as they are...

[kghemtp]

Resq, you're right with that thought, but we're thinking that for "normal" uncomplicated childbirth, the BLS provider should have exposure to it beyond what we read in the text. Maybe the ALS providers should try to get into "troubled" childbirths & true emergencies where aggressive management is expected. Most of our L&D time is generally pretty straightforward.

[tanker5117]

Makes me think that EMT-B classes should do a little labor & delivery time as a good first exposure to such an event

I start my EMT-B class tonight. How much time do they normally spend on this?


Tanker

[kghemtp]

While it's been 11 years since the class, I don't know that it's changed much. You might expect a full class devoted to ob/gym emergencies & emergency childbirth, if I had to guess.

[SMB53172]

I recently started my EMT course and according to our syllabus, we have one four hour class devoted to Obstetrics which also includes Behavioral & Environmental Emergencies. That is the extent of our training.

Sharon

[CBlasek]

We do two 3 hour classes and a 4 hour rotation in the hosp in the delivery room as a observer on a 12 hour hospital rotation, the other 8 being in the ER. We also have a "practical" night, should be interesting seeing what they use to simulate it.

Charles
FDMT

[Resq14]

Originally posted by kghemtp
Resq, you're right with that thought, but we're thinking that for "normal" uncomplicated childbirth, the BLS provider should have exposure to it beyond what we read in the text.

I guess "normal" is relative... I just figure most moms aren't planning on delivering in an ambo. We're not usually called when everything is proceeding well. To assume it's "uncomplicated"... that's a big assumption with a lot riding on it, regardless of the statistics.

I'd want ALS for my wife and child(ren) ;) if she were to deliver prehospitally. I don't have anything fresh to add and am basically repeating myself, so I'll fade off into the wings on this one. :p

[Maher112]

I believe that it is a BLS call. I have been in the room as a coach for both of my friends babies. I do not think that it is that hard to deliver a baby. THe BLS provider does not do that much work, mom does. Also at the BLS level you are traind and have the knowlage to deliver a baby if you have to. The mother had no cause for consern she didn't know of any complcations so as far as you delivering the baby you were more then skilled to do so.

One other thing to is that you can't always count on the frist baby alway takes 24 hours. Babise come when that want to. You have to be prepared for anything when you get called to a women in labor

[DrParasite]

after consulting with an EMT instructor, I now realize that it is a poorly phrased question.

I've revised my opinion on the topic as well. When dispatched for "immanent birth", ALS should be requested (and in my opinion should respond no lights or sirens). when they arrive, they should stand in the corner and point and laugh at the male EMT as he partakes in a very gross experience. the kid pops out, breathing and with 10 fingers and 10 toes (well, 11 or 9 are permitted in louisiana:D ) the medics take a "Cancelled after arrival" call by the basics, and the BLS rig should transport both to the hospital.

so yes, it's a BLS skill (and should be treated as such), but it never hurts to have a medic standing in the corner (pointing and laughing works wonders) just in case something goes wrong.

[DaSharkie]

If I can eat popcorn and throw a few kernels at the EMT while he is doing so I'll go to the call. :D

[RoryEl]

The popcorn is popping. Do you like butter with your popcorn?

[Adam07003]

I have different opinions. Child Birth can be a BLS but then again, there is always the chance of a problem, thus you'd need ALS. But then again, everything BLS can really turn into an ALS problem. So i'm gonna go with BLS on this one. We have maternity kits on all of our rigs, if childbirh was not to be handled by BLS why would we outfit our rigs with maternity kits?

[Engine2FF]

As a Basic, Iv'e delivered two in the field so far. I firmly believe that if we are there for the right reasons, the patient should come first. With this in mind, we should prepare for the worse and hope for the best. That's why I personally feel a medic should be there "just in case". Just an opinion.

Jimbo
FF/EMT-B

[emtcsmith]

I totally disagree with "just in case"...

A person who has pain in the back of his mouth for a week could all of a sudden stroke out and die, so just in case it should have a medic right?

The traffic accident with a stable patient with only neck an back pain may all of a sudden stop breathing, so just in case all accident patients should have a medic right?

The heart attack patient across the street from the ED should wait on scene with the BLS crew until the medic arrives from 10min away, just in case right?

[RoryEl]

scratching my head.
I wonder if its attitudes like these that make people cringe at the thought of delivery at home (by EMS). Little or no real life experience or practice and a prevailing attitude of I'm too important to be called out where a prolapse cord, nuchal cord, or meconium stain might jeopardize a new life, and devastate others. So why are there ambulances stationed at concerts, fairs, rodeos, sporting events, and major attractions? Just in case something happens? I consider delivery to be a major event, with high potential risk. Heck, I want the most qualified person available to attend to a delivery, not the least trained, least paid, least experienced person I can find. Really, if this is your attitude then a career change should be in your future.

[emtcsmith]

It's a matter of the most appropriate resource being called. When there are complications and when arrival of ALS can happen before arrival at a hospital then so be it. But, at major events where you stage resources then you can expect there to be the need for ALS just like you station ALS in an EMS system expecting the need. But a good majority of EMS calls (based on the system) don't require ALS, including "uncomplicated" child birth.

[RoryEl]

I'm so glad you know in advance when you're going to have a complicated child birth. Do you tell fortunes on the side too? Wait how much do I weigh? Really, you don't know what you got till you get there and if you think obstetrics is BLS then you've missed the ongoing obstetrical crisis raging in the USA

[mitllesmertz1]

If ya think about the actual problems involved in L&D, I have to agree it's pretty much BLS.
Anyone take that premature/neonatal class? Forget what it was called, good class though. (edit-found it.)

“Pearls” of Neonatal Resuscitation��:
- Only 1.2 babies in 1,000 need chest compression
-Only 1.2 babies in 1,000 need chest compression
and/or drugs and/or drugs
- Babies who need chest compression and/or drugs Babies who need chest compression and/or drugs
are either very acidotic or are not being ventilated are either very acidotic or are not being ventilated
appropriately


Incidence of Neonatal Resuscitation����
- Depends on gestational age
- 10% of newborns require some assistance int transition
- 1% of prematures need “extensive resuscitation measures”
- .12% need CPR and/or drugs (Perlman Perlman, 1995) , 1995)
- Positive pressure ventilation:
0.4% at term
70% at 23 at 23-26 weeks

http://www.aap.org/nrp/instres/instres_slides.html

This class focused on premies, so by extrapolation the amount of healthy, full-term babies needing ALS is rather small.
Note that 0.4% of term babies needed ventilation!!!
And, most importantly, the number one thing I picked up from the class was that the baby needs to be (1)warmed, which is BLS, and (2) ventialted, which is BLS.
Since intubation of a newborn isn't all that fun, much less needed, good old BLS will do just fine.
If the kid doesn't come around with a few quick puffs, odds of surviving drop dramatically.

As for mommy, well, I didn't wanna look for numbers of how many massive hemorrhages or other ALS cases there are per total childbirths, but I think the odds are again rather low.


Bottom line? Good, well trained EMT-B can deal with the vast majority of childbirths, and if the kid really needs ALS, BLS is what they need for the first 5 minutes anyways.

[ColdFireJT]

If it's normal practice in a hospital for a woman to give birth with a physician in the room, then why wouldn't the same be true in the field? (Although since docs dont ride on trucks, you get a Medic instead.)

Childbirth is every bit as BLS in the hospital as it is in the field. So why do OB Docs still participate in childbirth? In case something goes wrong... Which is precisely why you need a medic there in the field.

[mitllesmertz1]

Following that logic, why isn't there an MD present at births done with a Doula, or midwife?
And is there any evidence that, for full-term/low-risk delivery, there is a higher incidence of bad-outcomes when an MD is not present?
I'm thinking there isn't.
And remember the numbers I just gave:
Positive pressure ventilation:
0.4% at term
That's 0.4% of full-term deliveries needed ventilation, the number needing drugs and CPR is even less.

Sorry, that pretty much settles it for me.

[AZCEP43]

UNCOMPLICATED delivery is absolutely BLS.

Women have been doing this themselves with little to no help for millenia. Do you really think that your ability to ventilate, start IV's, and push drugs will have much use.

Thank you mittle for quoting the actual numbers. Having ALS is all well and good, but BLS providers should be able to grasp the concept of not every situation needing them.

[firefighterbeau]

I vote for BLS, as long as the mother has had prenatal care and has been seeing her doctor. Around here we get alot of ppl that dont go see the doctor so in our case since were a ALS service we send ALS, but if a BLS crew is working we send what we have to. No complications, should be no problem for a BLS crew to handle.

[hydrotech]

i voted BLS even though this post is three years old and protocols have changed since...along with CPR and what not.

[profire1]

I say it falls in between. In MOST states id say BLS...However, West Virginia is still in the 1930's..Thier basics cant even intubate. In Ohio an EMT-I is capable of all the treatments a Medic can do EXCEPT, ACLS "Very Important" but represents only 2% of calls. EMT-I's can give 95% of the drugs Medics push and the ONLY procedure emt-i's cant do is a cric, Cardioversion and pacing.

[mitllesmertz1]

.Thier basics cant even intubate.

Is that a typo, or are you really upset that the EMT-B skills don't include intubation?

[Catch22]

Is that a typo, or are you really upset that the EMT-B skills don't include intubation?

Does any state allow basics to tube?

[AZCEP43]

Several states do, but individual medical directors tend not to.

[Catch22]

Several states do, but individual medical directors tend not to.

That's a first for me. I can't say I've ever heard of anyone allowing an EMT-B tube someone.

We are talking intubation as in using a laryngoscope and all, correct? Not just throwing down an EOA or combitube?

[RoughRider]

Didnt read the whole thread but in Nassau County, NY its BLS.

Apologies if this was stated earlier.

[DrParasite]

That's a first for me. I can't say I've ever heard of anyone allowing an EMT-B tube someone.

We are talking intubation as in using a laryngoscope and all, correct? Not just throwing down an EOA or combitube?those that do tend to be states in the middle of nowhere where your typical transport times can be an hour and up from the scene to the nearest hospital. ALS intercept times can be almost as bad. Hence the reason why they give BLS added tools.

[AZCEP43]

That's a first for me. I can't say I've ever heard of anyone allowing an EMT-B tube someone.

We are talking intubation as in using a laryngoscope and all, correct? Not just throwing down an EOA or combitube?

Yes, full endotracheal intubation using a laryngoscope. The state of Arizona has only recently moved to allowing basics to use a combi-tube. When the 1999 curriculum came out, the powers that be decided to allow basics to perform ET intubation, but not the alternatives.

[mitllesmertz1]

only tubing dead people, I'm assuming?
since they can't start an IV, kinda hard to do RSI...

[bossteen]

oh god I hope its only dead people....

[AZCEP43]

Yes, it was only respiratory +/- cardiac arrest that was allowed. Very few medical directors actually signed off on it anyway.

And many of them were allowed to start IV's, but not give any medications through them. A rather half-****ed idea to begin with.