RE: Advice / Opinions

[Mauseth Patrice <Patrice.Mauseth@HCAHealthcare.com>]

I agree.  It is always better to deliver in a hospital setting regardless of
how primitive that may seem.  Call the neonatal team immediately.  It is a
HCFA
violation to do an interfacility transport on a laboring patient.  It states
you cannot transport until she is stable, which is defined as delivered
(including delivery of the placenta).

We have a strict policy of not transporting women who might deliver
en-route.

> -----Original Message-----
> From:	KReninger@aol.com [SMTP:KReninger@aol.com]
> Sent:	Tuesday, March 05, 2002 9:41 AM
> To:	flightmed@flightweb.com
> Subject:	Re: Advice / Opinions
> 
> 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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