transfer kit for laboring moms

Altalorraine · Oct 19, 2006

What do you use as first line for preterm labor? Does it vary if with length of gestation? Does it vary if delivery seems imminent as opposed to just regular contractions?
Any other ideas for improvement? We owe these moms more than just a quick transfer- if we can start treatment we should.

I think what you really should have is a close working relationship with an OB care center so they can direct the care of patients from a distance. I don't think people not in an OB speciality should mess around with treating OB cases on their own; consultation is required. OB is an extremely complex specialty with potential for bad outcomes and litigation. (Suppose you gave terbutaline to an abrupting woman to "stop her labor"- you could have a massive hemorrhage.) If delivery is imminent, you can't stop it (nor should you in many cases. And yes, treatment varies depending on gestation, maternal/fetal condition and provider preference.

That said, I can think of several things you could do. First, put an 18 gauge IV in; when we get patients with 20s we have to stick them again. The second thing is have betamethasone on hand (follow established guidelines for use). Finally, one lifesaving thing you could have in your kit is Cytotec (misoprostol) to manage postpartum bleeding.

Altalorraine

**canoehead, BSN, RN** · Oct 19, 2006

I'm not talking about treating, other than those that come to the hospital ER, and we stabilize as best we can and transfer them. I think the woman I referred to was in our ER for 15 minutes, and then in the ambulance elsewhere. BUT I want to provide her with the best chance we can give her while she's here. I am trying to develop a list of meds/equipment to grab when we need to go on the road with a laboring mother.

Ambulance protocols and EMTALA both state we cannot divert without assessing women and then getting hold of an OB doc that will accept them, and doing all the !@#$@#$ required paperwork. So 15 minutes was a minor miracle. I've had a mum stay with us for 90 minutes JUST to get all the transferrring ducks in a row, meanwhile she could have been treated to stop labor, mature baby's lungs, etc.

We need to do better, can you help?

Altalorraine · Oct 19, 2006

I'm not talking about treating, other than those that come to the hospital ER, and we stabilize as best we can and transfer them. I think the woman I referred to was in our ER for 15 minutes, and then in the ambulance elsewhere. BUT I want to provide her with the best chance we can give her while she's here. I am trying to develop a list of meds/equipment to grab when we need to go on the road with a laboring mother.
Ambulance protocols and EMTALA both state we cannot divert without assessing women and then getting hold of an OB doc that will accept them, and doing all the !@#$@#$ required paperwork. So 15 minutes was a minor miracle. I've had a mum stay with us for 90 minutes JUST to get all the transferrring ducks in a row, meanwhile she could have been treated to stop labor, mature baby's lungs, etc.
We need to do better, can you help?

I don't understand how you are not talking about treating. Where I work our docs will hold hour-long rounds to decide how to treat a PTL patient. I don't know what useful thing can be done in hurry other than BMZ (which I suggested) and perhaps mag (which you said you had). The truth is, *nothing* has been shown to prevent preterm delivery.

I understand you are traumatized by the delivery of the 23 weeker, but you have to know that even a big hospital OB department probably wouldn't have been able to stop it.

Altalorraine

**canoehead, BSN, RN** · Oct 19, 2006

I'm talking about what we should have available in a kit to go with the patient on the ambulance.

Trauma Columnist · Oct 19, 2006

Tina - I'm no help with birthin' babies, but wanted to send some positive thoughts your way. I too worked in the ER for 10 years. My only experience was a lady with 17 week twins who delivered in triage - it is still traumatic for me 9 years later!!!

**canoehead, BSN, RN** · Oct 19, 2006

Thanks, I need and appreciate the good vibes.

bagladyrn, RN · Oct 20, 2006

There's really not enough equipment you can carry with you in an ambulance to manage a 23 weeker delivered enroute (or enough personnel either).

This really isn't the place to be suggesting meds either. I'd suggest contacting your nearest/most used high risk facility for a set of protocols/orders which could be initiated at your facility while arranging the transfer. With these in place you could then set up your box of supplies to have at hand whenever this occurs.

From what you said and didn't say in your post, this must have been a really horrible experience for you. I can say from experience that you won't get over it immediately, but talking helps as does what you are doing in directing your energy into prevention for the next time.

SmilingBluEyes · Oct 20, 2006

The only things we really have to have for transfer are the mounds of paperwork, including parental consent for transport and that is about it. Where I am, the baby and/or mom are tranferred with the IVs and meds we have started and the paperwork/insurance cards (if it's mom being transported) and that is about it. The transfer team really does the rest and has what they need to complete transfer.

MemphisOBRNC, BSN, RN · Oct 20, 2006

As far as equipment, I would STRONGLY suggest you take resuscitation equipment for a neonate such as an Ambu bag with infant masks (I forget the sizes but they are for premie and term infants), laryngoscope handle and size 00, 0 and 1 blades as well as ET tubes 2.0, 2.5, 3.0, 3.5, and 4.0. I would bet that no EMS unit is going to have equipment that small. You may also consider taking a DeLee.

I agree that you should contact the OB unit you transfer to and coordinate care with them. All instructions, policies, protocols etc. you get need to go through your hospital's Med. Exec team for approval. Make sure you have the information in writing and keep it on file for 19 years! You may need to refer back to it years down the road. And make sure you would be able to validate anything you do! I would suggest any nurse that rides with an OB patient be trained in NRP and have attended some "OB Emergencies" classes.

I don't want to recommend meds., either, but the NRP course could help guide you in care of the baby. Hope this helps.

SmilingBluEyes · Oct 21, 2006

Yes great suggestions by Memphis!!!! Make sure you have NRP and resus. equipment is essential. Great posts so far.

Good luck to ya, Canoe. I feel your stress here.