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October 2024; Volume 13, Issue 10
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Utah Emergency Medical Services for Children
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Pedi Points
Tia Dickson RN, BSN
PCH Trauma RN, Utah EMSC Nurse Clinical Consultant
When EMS gets the call for a surprise delivery, it’s game time—baby’s on the way. Neonatal deliveries in the field mean EMTs suddenly become labor coaches, catching the newborn and handling immediate care, like suctioning airways and keeping the baby warm. Meanwhile, the new mom’s needs aren’t forgotten, with a quick focus on monitoring for bleeding and making sure she’s stable and hydrated. It’s a fast-paced, high-stakes event, but one that EMS is trained to handle, with plenty of gloves and deep breaths to go around. Let’s refresh those skills.
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Management of Maternal and Newborn Issues in the Community
Wendy Naylor RN, BSN
Alta View Hospital, Women’s Services
Excerpts from September 9th, 2024 PETOS
Maternal morbidity and mortality in the United States is at about 18%. The rest of the developed countries like Europe, China, and Japan are at 2 and 3% so we have a long way to go.
Utah birthing statistics
The current status in Utah: births overall are decreasing, at home births are increasing.
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5% of Utah births are planned to occur out-of-hospital
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10% of planned out-of-hospital births result in transfer to hospital.
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Some women choosing to deliver out-of-hospital have notable risk factors
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Neonatal mortality rates in Utah are higher for planned out-of-hospital births (2.6 vs. 0.8 deaths/1,000 births)
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Hypoxic ischemic events are more likely in planned out-of-hospital births than in hospital births (11.56 compared to 1.37)
Women choose home births for several reasons: to avoid unnecessary medical interventions, to have greater control and autonomy during childbirth, to stay in a familiar and comfortable environment, or because of negative past hospital experiences. Many women trust their body’s natural ability to give birth and want a more personalized experience. In Utah, women who plan home births tend to be older, more educated, and more likely to be married than those who opt for hospital births. It’s important for healthcare providers to support these choices and be sensitive to each situation. When EMS is called to assist, the family may feel it as a setback to their birth plan, so empathy and understanding are key.
The law
Utah Code 38-77-304 states. “parents have the right to deliver their baby where, when, how, and with whom they choose, regardless of licensure.” State-specific hospital regulations and the Emergency Medical Treatment and Labor Act (EMTALA) establish the legal framework for requiring to hospital care.
Transfer information
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When called you will want to gather the following information
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Their primary concern
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Gestational age/due date
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Risk factors for this pregnancy
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Last feeling of fetal movement
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Fluid intact or ruptured/color if ruptured
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Current background
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Previous birth history
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Chronic health concerns
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On Scene
After establishing scene safety you will want to ensure that the mother is in the best position to support uterine blood flow (not flat on her back).
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Intravaginal examinations are NOT appropriate in the field and are not needed. If this was performed in the presence of a placenta previa it could worsen the condition.
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Examination of the external genital in important to be looking for a presenting fetal part, the type of fluid being expelled or the presence of an umbilical cord.
Normal delivery and presentation
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EMS will assess the mother’s stage of labor. In stage 2, active delivery, contractions are strong, and the mother feels the urge to push. If delivery is imminent, guide the baby’s head out slowly. Once the head is delivered, allow it to rotate and check for a cord around the neck. If present, gently pull it over the head. If the cord is tight, clamp it in two places and cut between the clamps. If no cord is present, gently pull downward on the head to release the shoulders and deliver the body. Dry and stimulate the baby; suction is only needed if meconium staining is present. Place the baby on the mother’s chest and monitor for signs of healthy transition, including respiratory effort and movement. Delayed cord clamping can be considered if the baby is doing well. In the 3rd stage of labor, the placenta is delivered. EMS can pull gently to guide the placenta out.
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Breech presentations
Support mother in a good position for uterine blood flow and transport quickly. Often the body will deliver and the head may get stuck. A provider may apply pressure on the symphysis pubis to help dislodge it.
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Shoulder dystocia
The most common birth complication is shoulder dystocia. After the head is delivered, it may retract back, known as the turtle sign. In this case, perform the McRoberts maneuver. Always report this type of delivery to the receiving hospital so they can assess for fractures or birth trauma.
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Umbilical cord prolapse
Providers should hold the presenting part off the cord until they feel a pulse in the cord, then transport the patient to the hospital. These cases typically require a C-section for delivery.
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Vaginal bleeding
Vaginal bleeding before delivery can have several causes:
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Bloody Show: A normal sign of labor, as the cervix dilates. This bleeding is usually light and mixed with mucus.
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Placental Abruption: A serious condition where the placenta detaches from the uterine wall, causing heavy bleeding and pain. This requires immediate medical attention.
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Uterine Rupture: A rare but severe condition where the uterus tears, leading to internal and sometimes external bleeding. It often occurs in women with previous uterine surgeries, like C-sections.
After delivery, approximately 700 mL of blood flows to the uterus every minute. If bleeding continues, healthcare providers assess the four T’s of postpartum hemorrhage:
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Tone: Uterine atony (the uterus not contracting or firming up) is a common cause of hemorrhage. Treatment includes fundal massage to encourage uterine contraction and, if needed, medications like oxytocin.
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Trauma: Lacerations or tears in the birth canal can lead to significant bleeding. Treatment involves applying gauze and pressure to stop the bleeding and, if necessary, surgical repair.
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Tissue: Retained tissue, such as parts of the placenta, can prevent the uterus from contracting properly. Treatment often requires a dilation and curettage (D&C) to remove the remaining tissue.
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Thrombin: Coagulation issues, such as a clotting disorder or a hypertensive complication like HELLP syndrome, may lead to excessive bleeding. In these cases, tranexamic acid (TXA), a medication that helps reduce bleeding, may be considered.
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Most newborns transition well after birth with minimal assistance—just keep them warm and dry. However, if a baby is limp, flaccid, and not making any respiratory effort, immediate ventilation support is necessary.
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During newborn resuscitation, the baby should respond by increasing their heart rate. If this doesn’t happen, use the M.R.S.O.P.A. mnemonic to troubleshoot ventilation:
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M: Mask adjustment—ensure a proper seal.
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R: Reposition the baby’s head (sniffing position).
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S: Suction the mouth and nose if needed.
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O: Open the mouth slightly.
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P: Pressure increase—gradually raise ventilation pressure.
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A: Airway alternative—consider an advanced airway if necessary.
This sequence helps identify and fix common ventilation issues during resuscitation. Chest compressions should only begin once you have ensured adequate ventilation, which means you’re effectively moving oxygenated blood. Compressions alone won’t be effective without oxygen in the blood.
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For additional guideline direction check out the UPTN website or the new app, “Utah PTN” on android and apple devices.
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CME credit for this issue
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Training officers may review the topic above as a team training AND perform a simulation/skills check as directed. Once complete, send a roster of participants to Utah.PETOS@gmail.com and those listed will be issued 1-hour of CME credit from the Bureau of EMS, DPS.
Individuals who don’t have a training officer can get CME credit on their own by viewing a PETOS presentation in our archives and completing the instructions on the webpage.
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Our HRSA representative will be visiting Utah
The Emergency Medical Services for Children (EMSC) program is a US federal government health initiative. It is administered by the U.S. Department of Health and Human Services ’ Health Resources and Services Administration (HRSA), and the Maternal and Child Health Bureau (MCHB).The HRSA representatives for Utah will be visiting on October 15-17. We look forward to welcoming them.
EMSC Pulse
National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!
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Happy Emergency Nurses Week (Last Week)
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Autism awareness training (agency and hospital)
If your agency is interested in the John Wilson Autism Training or in receiving the free autism kits, contact Jeff Wilson, PM @jeffwilson122615@gmail.com.
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Do you know about the Medical Home Portal?
The Medical Home Portal is a unique source of reliable information about children and youth who have special health care needs (CYSHCN) and offers a “one-stop shop” for their:
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PECC development
For Utah hospital and EMS Agency PECCs
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Emergency Nurses Association (ENA) would like to recognize you!
ENA is holding their annual awards banquet and they aim to have diverse representation from all corners of the state, encompassing not only nurses but also EMS professionals.
Please note that the nomination period will remain open for approximately two more weeks, with the final deadline set for October 15th.
Please visit our website www.utahena.org/awards to view the various award categories and their respective descriptions, along with the nomination link.
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Understanding the PECC role
For hospital PECCs
For EMS PECCs
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PECC quarterly meeting
You will receive an invitation with the link through email. If you are a PECC and don’t receive this invitation contact our program manager, Jared Wright jaredwright@utah.gov.
When?
Tuesday, Nov 19, 2024, 10:00 AM
Southern PECC workshop
PECCs are encouraged to attend an in-person PECC workshop each year to receive up-to-date pediatric training, direction for your PECC role, and to participate in networking with other PECCs statewide. These workshops are free to designated hospital and agency PECCs. We will offer one in the northern part of Utah and one in the southern part each year.
When?
TBA March 2025
Where?
St. George, Utah
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Pediatric education from Utah EMSC
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Pediatric Emergency and Trauma Outreach Series (PETOS)
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PETOS (pediatric emergency and trauma outreach series)
This course provides 1 free CME credit from the Office of Emergency Medical Services, DPS for EMTs and Paramedics. The lectures are presented by physicians and pediatric experts from Primary Children’s Hospital. The format is informal; inviting questions and discussion.
Upcoming topics
October 14, 2024 – Hyper and Hypoglycemia with Stuti Das, MD
November 11th, 2024 – Gun violence with Katie Russell, MD
December 9th, 2024 – Pediatric seizures with Maija Holsti, MD
02:00 PM Mountain Time (US and Canada)
Join Zoom Meeting
https://zoom.us/j/98193757707?pwd=UzdNeXppQUdtZ01KZUp2UFlzRk9vdz09
Meeting ID: 981 9375 7707
Password: EmscPCH
Archived presentations can be viewed and also qualify for CME credits. You can access them at https://intermountainhealthcare.org/primary-childrens/classes-events/petos. To obtain a completion certificate—follow the instructions on the website
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Other pediatric education for all
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Children’s EM-mersion webinar series
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Intermountain Children’s Health Emergency Management Team is offering a weekly (every Tuesday) 30-minute educational opportunity for all hospital-based EM’s and PECCs in Utah and the surrounding Intermountain West.
We will delve into different pediatric planning topics such as decontamination operations, reunification, behavioral health, isolation/quarantine, and more! The goal is to help you better plan for pediatric patients at your facilities!
This weekly series is designed for you to attend whenever you can—you do not need to attend all sessions.
Register here for the rotating topic schedule.
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University of Utah pediatrics ECHO 2024
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The Pediatrics ECHO is back! For those new to Pediatrics ECHO, you can earn CME for participating in a case-based learning session with experts in a variety of pediatric topics.
You can view previous session recordings and other programs on the Project ECHO page. CME is available for participation in these classes.
More Information
Note the University has a new EMS education website.
When? Wednesdays 12 – 1 pm (MT)
October 16, 2024 Pre-term Infant Follow-up Sarah Winter, MD
October 30, 2024 Primary Immunodeficiency in Children Adriana Andreae, MD, PhD
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University of Utah injury prevention learning series
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University of Utah’s EMS trauma grand rounds
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21st Annual Utah Trauma Network (UTN)
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Hospital-focused pediatric education
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Primary Children’s pediatric grand rounds
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Offered every Thursday, September-May
Offering both RN and MD CME
The pediatric grand rounds weekly lecture series covers cutting-edge research and practical clinical applications, for hospital and community-based pediatricians, registered nurses, and other physicians and practitioners who care for children of any age.
The series is held every Thursday, 8 a.m. to 9 a.m. from September through May in the 3rd Floor Auditorium at Primary Children’s Hospital and at Lehi a broadcast will be held in the Modersitzki Family Education Center: First floor in rooms 1 & 2.The lectures are also broadcast live to locations throughout Utah and nationwide. Click on this link to view the broadcast: https://www.youtube.com/channel/UCNQP-M_3-PdPDvnICr2Fjpg
Connect live
Click here for the PGR PCH YouTube channel to find the live broadcast. Archives (without continuing education credit) will be posted here within 1 week of the broadcast.
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6th Annual Teen to Adult Healthcare Transition Summit
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Certified Pediatric Emergency Nurse Review
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Emergency Medical Services for Children Utah, Bureau of EMS, Department of Public Safety
The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system.
Email: tdickson@utah.gov
Website: https://ems.utah.gov/
Phone: (801) 707-3763
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