My first pregnancy complications call.

[lukgiel]

So a week ago I received a call for pregnancy complications, I did those before, cramps, nausea etc and we transported, but this call, a 39 y/o female gave birth to a 10 week old fetus 10 minutes prior to our arrival, my partner, who's been in ems for 10 years, and ne, not even a year and I just froze, he asked me to go to the bus and get him 4x4s, peds kit, obgyn kit etc and while in the bus, I forgot what 4x4s were. It seems as if my mind went blank, I remained calm and I wanted to help him as much, I feel I could have done better. I had mva's, doa and those didn't bother me at all

Main point is, anyone have a call that they just froze up? I had another call of this nature yesterday and it seems I did way better, I guess the more you're exposed to it, the better

Thanks for reading

 

[medichopeful]

Everybody freezes up on calls from time to time. It happens to the best of us, myself included. The important thing is to not beat yourself up over it, but to instead look at what you could have done better, like you're doing which I give you credit for. More exposure will help you get better with these. More education will as well.

 

[lukgiel]

Everybody freezes up on calls from time to time. It happens to the best of us, myself included. The important thing is to not beat yourself up over it, but to instead look at what you could have done better, like you're doing which I give you credit for. More exposure will help you get better with these. More education will as well.

Thanks, I apologized to my partner, and asked him on feedback and what could I have done better, and went over my obgyn protocols

 

[Angel]

that's all anyone can ask for honestly.

 

[Christopher]

So a week ago I received a call for pregnancy complications, I did those before, cramps, nausea etc and we transported, but this call, a 39 y/o female gave birth to a 10 week old fetus 10 minutes prior to our arrival, my partner, who's been in ems for 10 years, and ne, not even a year and I just froze, he asked me to go to the bus and get him 4x4s, peds kit, obgyn kit etc and while in the bus, I forgot what 4x4s were. It seems as if my mind went blank, I remained calm and I wanted to help him as much, I feel I could have done better. I had mva's, doa and those didn't bother me at all

Main point is, anyone have a call that they just froze up? I had another call of this nature yesterday and it seems I did way better, I guess the more you're exposed to it, the better

Thanks for reading

These are tough calls for anybody, really. You will certainly have these calls where you need to prepare yourself mentally, and if you don't have the time you'll have to do it on scene.

I try to help my partners out (I'm one of the odd ducks that doesn't "feel" like normal humans should) by putting together a rough game plan before we leave the truck. Roles are assigned and the first two minutes are scripted to give them time to cope if they need it.

 

[SeeNoMore]

The way I see it, calls where you leave a lot to be desired that don't end poorly for the patient (or at least not because of you) are an amazing gift.

Now you have had that first experience. You feel motivated to improve and hopefully will. Don't beat yourself up. Just make sure you learn some lessons and move on.

Best of luck.

 

[KellyBracket]

I'm just checking - it was really a 10 week estimated gestational age? If so, there was absolutely nothing to be done for the fetus - the only patient was the woman. Even at double that (20 weeks EGA), the odds of fetal survival are zero.

As for freezing, I'm pretty sure that you felt far worse internally than you appeared externally. Use this opportunity to get prepared for the "next time."

 

[ZombieEMT]

I assume that you meant to say that the women was an estimated 10 weeks pregnant?

Just remember. You are human. Sometimes EMT/Paramedic training does not prepare you for certain things on the emotional side. Its hard to see something like that. Its also not common. Just try to focus on training and function in the best interest of your patients. Its okay to freeze on bad crap, as long as you can snap out of it quickly.

 

[Christopher]

I'm just checking - it was really a 10 week estimated gestational age? If so, there was absolutely nothing to be done for the fetus - the only patient was the woman. Even at double that (20 weeks EGA), the odds of fetal survival are zero.

As for freezing, I'm pretty sure that you felt far worse internally than you appeared externally. Use this opportunity to get prepared for the "next time."

I've been unfortunate enough to deal with those in the 20 week range; fused eyes, near agonal apical heart beat, smaller than a can of soda...you'd love to do more, but even with a full NICU team there will be no positive outcome.

Something I forgot to stress earlier was just who exactly your patient is in these situations, as it is not the fetus. If the fetus has signs of life post-delivery, an accurate time of death will be desired by the hospital.

My approach has been to swaddle the fetus, explain the situation to mom (our actual patient), ask if she'd like to hold him/her (check gender to avoid an awkward usage of "it"), explain that you may need to provide mom medical care (post-partum hemorrhage, etc), and if you're not waiting on other family to accompany mom (or mom is unstable) begin moving to the hospital.

This may be one of those weird times where you hang out on scene waiting on a family member, provided mom is stable, so that folks can start the grieving process.

 

[lukgiel]

I've been unfortunate enough to deal with those in the 20 week range; fused eyes, near agonal apical heart beat, smaller than a can of soda...you'd love to do more, but even with a full NICU team there will be no positive outcome.

Something I forgot to stress earlier was just who exactly your patient is in these situations, as it is not the fetus. If the fetus has signs of life post-delivery, an accurate time of death will be desired by the hospital.

My approach has been to swaddle the fetus, explain the situation to mom (our actual patient), ask if she'd like to hold him/her (check gender to avoid an awkward usage of "it"), explain that you may need to provide mom medical care (post-partum hemorrhage, etc), and if you're not waiting on other family to accompany mom (or mom is unstable) begin moving to the hospital.

This may be one of those weird times where you hang out on scene waiting on a family member, provided mom is stable, so that folks can start the grieving process.

The female gave birth 10 minutes prior to our arrival, and it was dead, the female was going to get an abortion, so it didn't have that much of an impact on her, I didn't have a problem with the dead fetus, I know I wouldn't be able to do anything, whether me as an emt or my medic partner. It just shocked me as it was a first call of it's kind, deff nothing routine which is why I froze haha

 

[Brandon O]

I've been unfortunate enough to deal with those in the 20 week range; fused eyes, near agonal apical heart beat, smaller than a can of soda...you'd love to do more, but even with a full NICU team there will be no positive outcome.

I suppose there could be a difficult situation with a delivery in the early 20s-ish wks if you don't know the exact gestational age. Hard to know if it might be viable.

I wonder what the earliest preterm that's been delivered in the field with a good outcome is...

 

[Christopher]

I suppose there could be a difficult situation with a delivery in the early 20s-ish wks if you don't know the exact gestational age. Hard to know if it might be viable.

I wonder what the earliest preterm that's been delivered in the field with a good outcome is...

AAP's recommendation is gestation based at 23 weeks (ACLS says 23 weeks or 400g), but numerous protocols seem to suggest 20 weeks. When I'd last looked at it there was no good data for <22 weeks, but that there were some "survivors" albeit with extreme neurological dysfunction. One editorial noted we only don't have these good outcomes because nobody attempts it (i.e. self-fulfilling prophecy).

I've only found one case report published about EMS and an extremely pre-term infant...although one not necessarily in our favor:

bstract
The rate of premature infant mortality has decreased over the last several decades, with an accompanying decrease in the gestational age of premature infants who survive to hospital discharge. Emergency medical services (EMS) providers are sometimes called to provide prehospital care for infants born at the edge of viability. Such extremely premature infants (EPIs) present medical and ethical challenges. In this case report, we describe an infant born at 24 weeks into a toilet by a mother who thought she had miscarried. The EMS providers evaluated the infant as nonviable and placed him in a plastic bag for transport to a local emergency department (ED). The ED staff found the infant to have a bradycardic rhythm, initiated resuscitation, and admitted him to the neonatal intensive care unit. The infant died seven days later. We review the literature for recommendations in resuscitation of EPIs and discuss the ethics regarding their management in the prehospital setting (PubMed).

I would imagine it is reasonable to begin resus if known gestational age >22 weeks, or signs of life and you have appropriate equipment for the child's size, or a short transport (<5 mins?) is possible to a specialty resource center. If you have none of the equipment necessary to deliver even BLS care due to the patient's size, I'm not sure resuscitation is a good answer.