Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review

McLelland, Gayle E., Morgans, Amee E. and McKenna, Lisa G. (2014) Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review. Emergency Medicine Journal, 31 4: 345-350. doi:10.1136/emermed-2012-202309

Author McLelland, Gayle E.
Morgans, Amee E.
McKenna, Lisa G.
Title Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review
Journal name Emergency Medicine Journal   Check publisher's open access policy
ISSN 1472-0213
Publication date 2014-04
Sub-type Article (original research)
DOI 10.1136/emermed-2012-202309
Open Access Status
Volume 31
Issue 4
Start page 345
End page 350
Total pages 6
Place of publication London, United Kingdom
Publisher B M J Group
Collection year 2015
Language eng
Formatted abstract
Objective: While infrequent, unplanned births before arrival (BBAs) are clinically significant events at which, conceivably, paramedics will be the first health professionals in attendance. This review aims to demonstrate that paramedics not only attend and transfer birthing women, but also use critical clinical and decision-making skills. It further proposes strategies that will support paramedics manage out-of-hospital obstetric emergencies.

Design: The bibliographic databases EMBASE, MEDLINE, CINAHL and Maternity and Infant Care were searched from 1991 to 2012 for relevant English language publications using key words and Medical Subject Heading (MeSH) terms. Data were extracted with respect to study design, incidence of BBAs, attendance of paramedics, complications and recommendations.

Results: Fourteen studies were selected for inclusion arising from the US, UK and Europe. While all studies acknowledged paramedics attend BBAs, seven reported the incidence of BBAs attended by paramedics, and two discuss issues speci fically encountered by paramedics. Paramedics attended between 28.2% and 91.5% of all BBAs. While the articles reviewed noted that most of the births encountered by paramedics were uncomplicated, they all reported maternal or neonatal complications. Eight articles reported the most common maternal complication was excessive bleeding after birth, and nine reported the most frequent neonatal complication was hypothermia regardless of gestation.

Conclusions: Paramedics need to be adequately educated and equipped to manage BBAs at both undergraduate and graduate levels. Protocols should be developed between health and ambulance services to minimise risks associated with BBAs. A dearth of information surrounds the incidence of BBAs attended and the management performed by paramedics highlighting the need for further research.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Nursing, Midwifery and Social Work Publications
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Created: Wed, 15 Oct 2014, 11:26:07 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work