An Emergency Medical Technician (EMT) is an emergency responder trained to provide emergency medical services to the critically ill and in-jured. Once thought of as an "ambulance driver", the modern EMT performs many more duties than in the past, and responds to many types of emergency calls, including trauma and medical emergencies such as heart attacks, stroke, hazardous materials exposure and childbirth.
The above female child was delivered inside the ambulance at 2:48 a.m. and childbirth handled by two AEMS trained EMT's Philip Klarc and Ronn Gabriel last October 15, 2014 while on their way to the hospital.
Photo : AEMS Nurse /EMT Philip Klarc with the newborn.
Photo : AEMS/Lifeline EMT Ronn Gabriel with the newborn
PROCEDURE FOR OUT OF HOSPITAL DELIVERY:
One person takes charge, others play gofer as needed. In this case it was Philip Klarc who took charge. Philip graduated a nurse and took the full EMT course with AEMS.
- Clear out non-helpful bystanders.
- Keep calm, keep voice low.
- Set up clean area that won't accidentally get messed up by mother.
- Lay out all necessary equipment, set up oxygen.
- Wash hands and arms if there is time.
-Place clean drape under mother's buttocks (be prepared for gofer to clean away feces if necessary)
-Explain to mother what is happening, as it happens.
-As the perineum bulges, place hand gently but firmly over the introitus and the perineum, to prevent sudden uncontrolled expulsion of the fetal head.
-Encourage the mother to pant or push very gently, explaining you want to avoid a tear.
- As the head emerges, keep firm gentle pressure on head and perineum until chin delivers.
- Feel for the cord behind the top ear. If found, gently tug to see if it will slip over the head. If tightly wrapped, clamp in 2 places and cut between.
- Suction the baby's mouth and nose. This is mainly important if the amniotic fluid is green or brown colored. Otherwise it's probably not a vital step and can actually cause breathing problems.
[Note - It is important to suction the mouth before the nose. "The mouth is suctioned first to ensure that there is nothing for the infant to aspirate if he or she should gasp when the nose is suctioned." [From the AAP/AHA Textbook of Neonatal Resuscitation, rev. 3/95, p. 2-12.]
- After head rotates to face mother's thigh, gently press down on head to encourage the top shoulder to deliver.
- When you can see the baby's top armpit crease, lift up on the head to deliver the bottom shoulder. The rest of the baby should follow.
- Suction the baby's mouth and nose.
- Dry the baby vigorously, then DISCARD WET TOWELS and wrap the baby in dry warm clothes or blankets.
- Administer oxygen at 5 liters 1 1/2 inch from baby's face until trunk is pink and hands and feet less blue. Some cyanosis of extremities is expected. Keep rest of baby's trunk and head well covered while administering oxygen as the draft will chill the child.
- If not expected to get to the hospital soon, clamp and cut the cord 10-15 minutes after the birth. (clamp the cord about 3 inches from the abdomen, then 2 inches beyond that, and cut between the 2 clamps.)
- Place the baby on mother's chest, with head lower than feet to allow gravity to assist the baby in clearing the airway.
- Watch for sudden gush of blood and lengthening of cord. This means placenta has detached and is ready to be born. Provide gentle traction on the cord. Placenta will usually be pushed out easily by mother. If it doesn't, get to hospital as soon as possible. Normally, approximately one cup of blood is generally lost with the delivery of the placenta.
- After placenta born, immediately press fingers slowly and gently into abdomen at umbilicus - you'll feel the top of the uterus. It may be somewhat spongy or slightly firm or rock hard if she's having a contraction. Do slow and gentle circular massage to encourage contraction of the uterus. This is extremely important, especially if there's a constant flow of blood.
Expedite transport to hospital ASAP.
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