Pre-hospital Obstetric Emergency Training

Book Preface

Pre-hospital obstetric incidents make up a significant proportion of the more costly litigation claims against UK ambulance services. These claims are based either on an alleged failure to identify and manage a problem or lack of appropriate equipment for the treatment of a preterm baby.

For a number of years after the UK national paramedic curriculum was introduced in the UK, it included no specific training on the management of obstetric emergencies at an ‘advanced life support’ level. Most staff received only a half-day of lectures during their initial ambulance technician training at the beginning of their career. Since 1999, advanced obstetrics and gynaecology became a mandatory part of the paramedic course for new entrants but with the expectation that existing paramedics would receive update training. Our experience has indicated, however, that paramedics in many parts of the UK have not had the opportunity to do so.

A confidential enquiry into maternal and child health (CEMACH) report has indicated thatmany of the pregnant women dying ‘had chaotic lifestyles and found it hard to engage with maternity services’. The ambulance service may be the initial contact with the health service for these patients and their peers who become unwell but are fortunate enough to survive. The CEMACH report identifies the need for a widened awareness of the risk factors and early signs and symptoms of potentially serious problems in pregnancy, and makes a number of key recommendations that could be addressed in part by appropriately trained pre-hospital practitioners.

For example, it states:

All clinical staff must undertake regular, written, documented and audited training for:

• The identification, initial management and referral for serious medical and mental health conditions which, although unrelated to pregnancy, may affect pregnant women or recently delivered mothers
• The early recognition and management of severely ill pregnant women and impending maternal collapse
• The improvement of basic, immediate and advanced life support skills. A number of courses provide additional training for staff caring for pregnant women and newborn babies.