RE: High Risk OB dilemma

["Joe Kubitschek" <joekuby@sbcglobal.net>]

Dave your question has been a great educational experience.  I have to agree
with Pam, and acknowledge my ignorance to the BO-105 and lack of access.  I
still feel though that if both Doc's sending and receiving feel comfortable
with sending Mom for a 20 minute flight it is better to be in the facility
that has the expertise in delivery.  Waiting for a perinatal team and NICU
team is wise though.  After spending time in a NICU I found that Mom's that
were unable to travel with their baby(ies) suffered not only emotionally but
physiologically.  I am not saying that you should be gung ho and fly by the
seat of your pants, but I am saying that time can be lost and things can be
better for all by moving appropriately.  After rereading your scenario I did
see one key word that would make me nervous and that is "bulging" membranes.
This baby is going to need a lot of assistance quickly.  As stated, sugar,
temperature, airway concerns are going to be immediate and not to mention
infection risks.  That is why I thought go while the gettin is good.  If the
physician at the receiving hospital has accepted the patient under the
circumstance you described though, from my understanding, the patient was
accepted and I have to question if EMTALA issues do exist.  I am curious
what happened?  Did you transport or not?  How long did it take for this
baby to be born?  Pam is a better expert than I and I appreciate you asking
the question and have learned much.

Thanks

Joe

-----Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com]On Behalf Of Dave Sharpe
Sent: Sunday, August 03, 2003 1:20 PM
To: flightmed@flightweb.com
Subject: High Risk OB dilemna


Ok folks, here's a scenario for you.  Your service flies a BO-105
aircraft, and has an agreement with a local OB receiving facility to
provide transport for high-risk OB patients.  On these flights, you
send the aircraft with one Flight Nurse to the receiving facility to
pick up a Labor and Delivery Transport Nurse as part of your team, then
respond to the sending facility 20 minutes away (90 minutes by ground).
  Upon arrival, you find  a 26 week pregnant, G1P0 patient whose cervix
is dilated to 10 cm with intact but bulging membranes.  She came in the
day prior with contractions which were controlled with a MagSo4 drip at
3gm/hr.  She is no longer having contractions.  The sending physician
wants her transferred to the receiving specialty center to manage her
pre-term labor, but does have the capability to resuscitate a preemie
newborn if necessary.
1.)	Would you transport this patient?
2.)	For the sake of discussison, lets stipulate that you're not
comfortable with transporting the patient, but the L&D specialty nurse
and the receiving Perinatologist feel the patient is stable enough to
transport by air, and is not in danger of delivering precipitously
enroute.  Given this information, would you then transport the patient?


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