Destination and Bypass - Maternity

[croaker260]

This kinda bugs me. Why is it your responsibility to know what is or is not available at every hospital? How are you to know if the part time on call obstetrician at hospital ABC is currently available?

Well , our system is a bit different. The local hospitals are large enough that they have their respective areas covered 24/7. Back when one hospital didnt have 24/7 cardiac or neuro coverage, then we simply didn’t take them there for those emergencies (IE STEMI or STROKE). If the patient insisted, well then you can see what our polcy states. It has worked well in our system. Most patients listen to us when we explain things.

Our admin doesn’t play the musical hospital game. If a hospital wants to receive specialty patients, they do so 4 / 7 or not at all. Not every system does this and your own mileage in your system may vary depending on your situation.

Regarding the other comments regarding imminent Birth:

The only time you can tell if a delivery is complicated or if a baby is compromised is AFTER shit begins to hit the fan. Remember that 10% of newborns needing meds and intubation had none of the classic warning signs prior to delivery.

It is perfectly appropriate to take a imminent delivery to the closest emergency from staffed with a board certified ER doc in this situation. if the baby delivers in the process, great. If problems develop, then you are ahead of the eight ball.

YES, an EMT-B can deliver a baby in a pinch. Just like they should be able to manage an airway. Until you get into a failure to progress, or a breech baby who has the cervix spasming around its neck, or shoulder distocia? How about uterine rupture in an unintended VBAC? This may surprise you but both ER docs and family practice docs both train to deal with this, not just OB docs. And for good reason. But even paramedic programs do not touch on most of this, much less EMT courses. The list goes on and on and on and on why the plan should be to get the mom/baby to the closest ER to stabilize and then transport after stabilization/birth.

We just had a local pair of midwives.. (people with over 1500 live births each) lose their liscenses for being too cavalier with these situations (some deaths resulted) , thinking they could handle this. And this was with pre-screening and lots more experiance that 99% of the people n this forum would have. And things still went wrong for them. Why do we think we should attempt this when we have other options?

Its all fun and games until you get over your head and you realize that you just passed two other hospitals because you “thought I could handle it”. It is this exact situation that prompted the creation of the EMTLA laws 30 years ago. THIS EXACT SITUATION.

If you feel that strongly about it….You can always wait and do the transfer to the hospital of choice after the situation is stabilized.

Edited May 9, 2012 by croaker260

[croaker260]

Can your local ED do a breech birth or a placentia previa? If you suspected that this might be occuring could they intervene appropriately?

Your asking the wrong question...Can they managege a breech or placenta previa better than you?

In our area..the answer is yes. Your area may be different.

Our local ERs can (and have) done emergent and peri-mortum C-sections. I didnt say they like it. But they can.