Cash Rebecca E, Kaimal Anjali J, Samuels-Kalow Margaret E, Boggs Krislyn M, Swanton Maeve F, Camargo Carlos A
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Prehosp Emerg Care. 2024;28(7):890-897. doi: 10.1080/10903127.2023.2283892. Epub 2023 Nov 29.
Prehospital obstetric events, including out-of-hospital deliveries and their complications, are a rare but high-risk event encountered by emergency medical services (EMS). Understanding the epidemiology of these encounters would help identify strategies to improve prehospital obstetric care. Our objective was to determine the characteristics of out-of-hospital deliveries and high-risk complications treated by EMS clinicians in the U.S.
We conducted a cross-sectional analysis of EMS patient care records in the 2018 and 2019 National EMS Information System Public Release Version 3.4 datasets. We included EMS activations after a 9-1-1 scene response for patients aged 12-50 years with evidence of an out-of-hospital delivery or delivery complication, or where the patient was a newborn aged 0-<6 h. We examined patient, community, emergency response, and clinical characteristics using descriptive statistics.
Of the 56,735,977 EMS activations included in the 2018 and 2019 datasets, there were 8,614 out-of-hospital deliveries, 1,712 delivery complications, and 5,749 records for newborns. Most maternal (76%) out-of-hospital deliveries involved patients between the ages of 20-34 years, occurred on a weekday (73%), were treated by an advanced life support crew (85%), and occurred in a home or residence (73%). EMS-assisted field delivery was documented in 3,515 (34%) of all maternal activations but only 2% of activations with a delivery complication. Few patients received an EMS-administered medication (e.g., 0.4% received oxytocin). Supplemental oxygen was administered in 870 (15%) of newborn activations. Activations from counties with the most racial/ethnic diversity were more often treated by a BLS-level unit (16% vs. 12%, < 0.001), and activations from rural areas had significantly longer transport times (19.7 min [IQR 8.7, 32.8] vs. urban, 13.1 min [IQR 8.7, 19.7], < 0.001).
In this large, national repository of EMS patient care records from across the U.S., most activations for out-of-hospital delivery, delivery complication, or a newborn included only routine EMS care. There were potential disparities in level of care, clinical care provided, and measures of access to definitive care based on maternal and community factors. We also identified gaps in current practice, such as for postpartum hemorrhage, that could be addressed with changes in EMS clinical protocols and regulations.
院前产科事件，包括院外分娩及其并发症，是紧急医疗服务（EMS）遇到的罕见但高风险的事件。了解这些事件的流行病学有助于确定改善院前产科护理的策略。我们的目标是确定美国EMS临床医生治疗的院外分娩和高风险并发症的特征。
我们对2018年和2019年国家EMS信息系统公开发布版3.4数据集中的EMS患者护理记录进行了横断面分析。我们纳入了对12至50岁患者进行9-1-1现场响应后的EMS激活记录，这些患者有院外分娩或分娩并发症的证据，或者患者是0至<6小时的新生儿。我们使用描述性统计方法检查患者、社区、应急响应和临床特征。
在2018年和2019年数据集中包含的56,735,977次EMS激活中，有8,614例院外分娩、1,712例分娩并发症和5,749例新生儿记录。大多数产妇（76%）院外分娩涉及20至34岁的患者，发生在工作日（73%），由高级生命支持人员治疗（85%），且发生在家中或住所（73%）。在所有产妇激活记录中，有3,515例（34%）记录了EMS辅助现场分娩，但在有分娩并发症的激活记录中仅占2%。很少有患者接受EMS给药（例如，0.4%接受催产素）。在870例（15%）新生儿激活记录中给予了补充氧气。来自种族/民族多样性最高的县的激活记录更常由基础生命支持（BLS）级单位治疗（16%对12%，<0.001），农村地区的激活记录运输时间明显更长（19.7分钟[四分位间距8.7，32.8]对城市地区的13.1分钟[四分位间距8.7，19.7]，<0.001）。
在这个来自美国各地的大型全国性EMS患者护理记录库中，大多数院外分娩、分娩并发症或新生儿的激活记录仅包括常规EMS护理。基于产妇和社区因素，在护理水平、提供的临床护理以及获得确定性护理的措施方面存在潜在差异。我们还发现了当前实践中的差距，例如产后出血方面的差距，可以通过改变EMS临床方案和规定来解决。
