Fetal Doppler/Fetal Heart Rate Monitor

[Bethadone]

Our service is considering the purchase of fetal dopplers to carry on-car as we are a rural service with extended transport times, and lots of OBS calls.

Does anyone have any experience using these in EMS, if so...any comments on how useful a tool it was for you? Also, any suggestions for a particular model/brand?

Thanks!

[VentMedic]

I'm giving you a couple of links on another forum that has some info on different models and experiences.

http://www.flightweb.com/forum/viewtopic.p...showtopic=11492

http://www.flightweb.com/search.php?query=...amp;mode=search

[akflightmedic]

Great idea! I like the fact that your service is trying to expand their assessment abilities.

Few questions for you.

1. What are your extended times?

2. Does this service have the funds for these purchases, and is it absolutely necessary?

3. If they have the funding, is it because they are not purchasing somethign else much more needed just so they can have these?

4. Monitoring FHTs is a great tool, however, can you do anything about the situation, should you notice a decrease or increase of the FHTs?

5. What kind of training do you have planned? Give the average medic a doppler and they would be absolutely clueless as to where to place it for best sounds. Hell, most of them are clueless as to what position the fetus is in when inside the womb.

I ask all of this, not even knowing the price of the dopplers, but the service should consider cost of several devices versus actual use and need. Instead of buying a whole lot outright, why not field test one device and monitor the use and outcomes and see if it is worth pursuing further.

Having said all of this, the only time I ever used them was as a flight medic with extended flight times in the arctic. We had a lot of OBS there as well. September was a very popular month for deliveries...must be those cold Dec/Jan nights.

[Just Plain Ruff]

ak I agree.

training is very important and should be the first thought here.

second, what are you going to do if the patient (baby) exhibits slowing or increasing of the heart rate? NOt much but get them to the hospital. You can let the receiving hospital know of the slowing or increasing but you won't be able to do much about it in the ambulance.

Third, cost - maybe a pilot program of a couple different manufacturers. You might be able to try out several different dopplers from different manufacturers for a week or two and determine which is better suitable for the ambulance.

Good luck on this endeavor.

[Bethadone]

Thanks for the replies. In response to your questions:

I have been asked me to consult with the staff regarding suggestions for "capital purchases" as the municipal district partially funding the service would like a five year plan for capital purchases which they have agreed to fund. Now, we have just ordered 3 brand new ambulances with all the bells and whistles, plus new LP12's for all the units so all the "big" stuff is out of the way, and we have some money to play with.

Our ground transport times in our more remote bases range from 3-4 hours. It is up to the discretion of the attending medic/EMT whether or not to medivac the patient and for me personally I've had several OBS calls where the only complaint is "the baby hasn't moved in a couple days" and mom is just looking for a reassurance that everything is OK. So 4 hours later we get to the hospital, they take out the doppler and find a normal FHR, and then send her home. I think "why can't WE do that?" Now, I'm aware of the dangers of this being used as a "diagnostic tool" in EMS, it will definitely be a huge part of the training that having a doppler does not make the medic an obstetrician, and they should still go with what the patient is presenting with to decide whether or not to transport.

Also, I've had some maternity/trauma and maternity/alcohol or drug abuse calls where unless mom is in a critical condition, she gets transported by ground. The FHR monitor would allow our medics to have any additional piece of information to help them make the decision of whether or not to fly the patient out. Even if mom is totally asymptomatic, I can use the doppler to find signs of fetal distress - fetal bradycardia/tachycardia and decreased FHR variability and maybe with that new information, will fly the patient out instead.

In terms of training, I agree that it is important and if we purchase these, will definitely be a part of the process. But using a doppler isn't rocket science, after all - they rent them out to everyday expectant moms! Granted, finding the FHR can be tricky sometimes and I think we'll have some patients where it just won't happen but that is no different that the ped. you can't get a BP or pulse oximitry on so you use other assessment tools... these are tools we can use to assist us in making transport decisions and I think the more the merrier.

The model we're looking at piloting is the Huntleigh FD1+, manufactured by Huntleigh Healthcare. We would probably purchase three in total eventually if they get enough use and are used properly.

It's pretty cool that my job right now is to make a shopping list for the service, but I want to make sure it's money well spent.