Flightmed archive for September-2002
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Flightmed archive for September-2002

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RE: OB transport

David, Patrice, Jery et al:

Thanks for the advice. I guess the difference is in the definition of ultrasound. I was refering to using a doppler to determine fetal heart-rate and then combining that with palpation to determine lie. Not an abdominal ultrasound in the hospital diagnostic imaging suite sense of  the word. 

However I am not sure exactly which the Jery intended to determine.... Not to many teams fly with abdominal ultrasound machines, although I am sure that more will soon now they are small and available.

As to community standards etc, what was the purpose of the ultrasound? If it is to determine if the fetus is alive, twins or a breech presentation prior to deciding to deliver in the community or fly to a specialist centre, then I agree poor reading and poor outcome could be a concern. Brow presentations, nuccal cord and disporportion etc cannot be determined by a handheld doppler (at least not as far as I know) used for FHR measurement. 

On scene calls, where the team is from 1 to 4 hours from a community hospital (with abd U/S), and 4 to 8 to a tertiary centre (with a nursery and specialists etc) and no access to a MD, Midwife or NNP etc. the choice is to fly or deliver. We would love to have the equipment and skill to do full abd U/S but it is not likely to happen this decade for us. 

So far in 10 years operation, we have never had an adverse outcome -we also have never had an in-flight delivery. (Although we have had the odd stillborn, dystocia, nuccal cord, twins, breech etc usually because the mother was too far along in labour for it to be stopped - so a field delivery was the safest option.) 

With an overall average of only 18 (+/- 6) field deliveries annually from 140 or so fetal position assessments performed, we obviously don't have the depth of experience that a specialty team would have. And I am not aware of studies that show the optimum number of FHR/position assessments annually that would be required to "maintain proficency". However, there also is in almost all cases, no other option in our area. Sometimes we scoop and run, sometimes we stay and deliver. Flight duration, mothers condition/history, stage of labour, dilation and fetal position are all variables that constantly have to be assessed. 

I can't see how NOT attempting to determine fetal position prior to making these decisions can be better in a medico-legal sense - or from the mothers/baby's perspective!! I don't want to revisit the "get them to aurgery" debate again, as with the available resources in the Arctic, acceptable community medical standards are not the same as in the highly populated areas south of the 49th (or even 55th) parallel. In fact, the closest dedicated perinatal specialty team probably would have to come out of Seattle or Denver (possibly Anchorage?) as there are none in Edmonton, Calgary, Vancouver, Saskatoon or Winnipeg.   

Fly Safe. 

Duct tape is like the force, it has a light side and a dark side, and it holds the universe together.

>The above are 'Words of Wisdom'.   It is difficult enough to keep physicians
credentialed and comfortable in FAST ultrasounds in the Trauma Resus area
given the complexity (false negatives) of Ultrasound.
Granted, Fetal Presentation Ultrasound exam may be less complex than a F.A.S.T.
Ultrasound, but what is your "community Standard of Care"; given a poor outcome
when decisions for patient care were determined by this exam?
Just an opinion.
David Summers RN, etc
Jupiter FL

--- Mauseth Patrice <Patrice.Mauseth@HCAHealthcare.com> wrote:
>Just food for thought.  I'm responding from a specialty team that you didn't
>want to hear from...  Our hospital does over 4000 deliveries per year.  We
>have a hand full of RN's who are certified through AWHONN for ultrasound.
>They barely do enough ultrasounds to keep their skills up.  I always caution
>people doing more and more specialty work when they may not do enough
>consistently to maintain their skills.
>Patti Mauseth, RN
>Perinatal Transport/Outreach Coordinator
>Good Samaritan Hospital
>408 559-2153
>> -----Original Message-----
>> From:	Ken Lawson-Williams [SMTP:Macgyver@FlightMedicMail.com]
>> Sent:	Monday, September 16, 2002 10:58 AM
>> To:	flightmed@flightweb.com
>> Subject:	Re: OB transport
>> Medics as well as RN's are (and do) at Medflight (Yellowknife). Assuming
>> that you mean determining the fetal lie by the use of traditional handheld
>> doppler in conjunction with 'Leopoulds' style hands-on assessment. 
>> We do about 1000 flights a year (6.5 hr average length, fixed wing) and
>> about 55% are primary transports (scene calls). Roughly 35% of all of our
>> flights in total are high risk perinatal/neonatal/pede patients - with
>> perinatal about 2/3rds of those. Only about 2/5 of our perinatal trips are
>> interfacility. Average out over 4 crews and you do about 35 perinatal
>> scene responses a year each. 
>> Fly Safe. 
>> Duct tape is like the force, it has a light side and a dark side, and it
>> holds the universe together.
>> --- message from "jery" <jery@internetcds.com> attached: << Message: OB
>> transport >> 

I would like to know if there are "garden variety" flight RN's that are trained in identifying fetal positioning by ultrasound.  I would like responses from flight programs that do the OB transports instead of using specialty OB teams.  Thanks.

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