Re: Advice / Opinions

[KReninger@aol.com]

First off, I don't' routinely deal with unstable OB-GYN patients in my role 
as an air medical provider, however I do deal with them in my role as an ER 
nurse in a regional referral center. We don't have L&D or a NICU, but the 
hospital next door with a connecting tunnel does.  Expectant mothers show up 
in distress from time to time.  We stabilize them and ship or if need be, do 
the delivery and deal with each patient separately.  Keep in that in mind, 
here's my two cents:

Given the relatively advanced gestational age of 34wks and instability of the 
mother, I would split this up into two missions.  Flying single provider (or 
single provider plus non air medical trained "helper") with either patient is 
not an optimal situation. I truly feel sorry for this MD. They are probably a 
family practice physician operating virtually on their own with little 
consultation or referral ability.  In addition, the 300-400 lb, G7P3, no 
prenatal care, presenting in labor patient is probably up there on the list 
of "worst nightmares" for any isolated rural physician.  The other one is 
watching a non TPA candidate AMI patient die in front of you for want of a 
cath lab.  I appreciate the MD's desire to get their patient to a safer and 
higher level of care as soon as possible.  They are plainly aware that their 
local system cannot deal with these two patients.  However, you cannot be 
their angle of refuge in every situation.   

The mother needs to stay there regardless of what type of aircraft or 
experienced crew configuration you are dealing with.  The birth will occur. 
The child will be about 6 weeks premature and require some form of 
resuscitation.  Just do it.   Plan the operation, operate the plan.  A plan 
is nothing but a basis for change, so expect and deal with Murphy as needed.  
Hopefully the mother will be relatively OK post delivery. Let the local staff 
deal with her as best they can. Focus on the baby, do what you can. Request 
the NICU transport team  early on as part of your plan.  Transfer care to 
them when/if they arrive.  Transport the mother yourself if needed.  If the 
mom is doing OK and you feel comfortable taking care of the kid, transport 
the baby.   

This is a bad situation all around. Resist the urge to scoop and run. Don't 
get in your aircraft under anyone's terms except yours.  The initial sending 
physician concept of how to transport this package is unacceptable. 

Hope it all went well for you - So how did it all turn out? 


Kristian Reninger
RN, BSN, CEN, NREMT-P
Flight Nurse
Mercy Flight Central

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