Reminder, the scenario and questions that were asked of a group of paramedic students:
You are called to the home of a 24-year-old female who is 36 weeks pregnant and in labor. You are met at the door and advised that she has had no prenatal care. You are also told that the patient has been previously admitted to the ER for an opioid overdose and that she is currently taking methadone. As you enter the bedroom you see that the baby has delivered. You find that the umbilical cord is still pulsating and begin to provide care to the newborn while the other crew assesses the mom. The newborn has an APGAR of 6 and is lethargic. The other crew finds what appear to be recent track marks and the boyfriend admits that he helped the patient shoot up with heroin to dull the pain of delivery.
Question #3 for the above scenario was when both crews decide to transport, do you transport the two patients together or separately? Why?
In regard to patient transport, if possible, the patients should be transported separately. We know the baby is the focus of patient care and will be on the gurney, secured appropriately. Are you going to be able to also take care of the mom? She just delivered a baby and has methadone and heroin in her system. Is it appropriate to ask her to sit on the bench or the captain’s seat after delivering a baby? What if she decompensates during transport?
Our textbooks recommends that we keep the baby warm with skin-to-skin contact, again in this instance the baby needs resuscitation. If the baby did not need resuscitation, are you going to trust the mom to hold the baby while under the influence of drugs? Is a sober mom going to be able to hold onto the baby during a collision of any speed? No, the G-forces will overwhelm her, and she will lose control of the baby potentially resulting in a devastating outcome
The pediatric transport recommendations published by the National Highway Traffic Safety Administration (NHTSA) calls for each patient to be transported and secured individually. And under no circumstances should a child be transported in the following manner:
- Unrestrained;
- On a parent/guardian/other caregiver’s lap or held in their arms;
- Using only horizontal stretcher straps, if the child does not fit according to cot manufacturer’s specifications for proper restraint of patients;
- On the multi-occupant bench seat or any seat perpendicular to the forward motion of the vehicle, even if the child is in a child safety seat
Is your agency prepared to transport a pediatric patient as per the expectations? If not, and there is an MVC, and a bad outcome will there be legal ramifications for your organization when this information is introduced in court? And if this is your call, you will be the one expected to answer these questions on the witness stand.
In the instance of this scenario, the mother should be transported separately. Your focus will be resuscitating the baby, are you going to ask the mom to sit on the bench seat or in the captain’s seat after she just delivered a baby? I wouldn’t. What are you going to do if mom, who is reportedly under the influence of methadone and heroin, deteriorates?
There are a couple of devices out there that would allow for skin-to-skin contact during transport, for example, the KangooFix, https://ferno.com/us/product/kangoofix-neonatal-restraint-system?hl=en-us.
Reference:
Bureau of EMS, Trauma & Preparedness. (2017). Safe Transportation of Children in Ambulances. Retrieved from http://www.ocmca.org/wp-content/uploads/section-4-ob-and-pediatrics/4.8-SAFE-TRANSPORT-OF-CHILDREN-FINAL-FINAL.pdf.
