A MOST COMPELLING READ
July 22, 2014
By Tracey Barron
A captivating article in the most recent issue of the Annals of Emergency Dispatch & Response (AEDR) chronicles an amazing call between an Emergency Medical Dispatcher (EMD) and a mother to-be (who we'll call Ann) caught short in getting to the hospital in time for delivery.
This is a phone call that should be mandatory in EMD classes since it clearly demonstrates the power of dispatch and our ability to influence so many lives.
She’s having a baby—alone
Ann's mother (who we'll call Sue) makes the call and reports that she and Ann are in places separated by at least an hour drive; this is Ann's first child and the baby has an undiagnosed true footling breech presentation.
Ann, who is in active labor, lives in an isolated, rural area, and she is alone. The estimated time of arrival of the nearest ambulance is about 20 minutes, and the same goes for a nurse—the woman’s cousin—reported to be en route.
Breech births are riskier than the birth of a head-down baby and just how risky they are depends on the baby’s positioning. Perinatal mortality is increased two- to four-fold with breech presentation, regardless of the delivery mode. Footling breech (one or both hips and knees extended, feet presenting) comprises 10 to 30 percent of all breech births.
The breech presentation was the calltaker’s first in six years of emergency communications, with the experience of recently becoming a first-time father. The birth of his child provided levels of confidence and empathy he might not have had otherwise.
Sequence of events
The EMD codes the call 24-D-1 (Pregnancy/Childbirth/Miscarriage – DELTA – Breech or Cord) and immediately sends the code to dispatch. Response is a single Advanced Life Support (ALS) crew sent lights-and-siren (“HOT”). The EMD tells Sue that it’s time they hang up so he can call Ann. The EMD instantly changes his directive to having Sue stay on the line and he will conference the call.
According to the article, the situation at Sue's home reminded the EMD of the emotional strain of seeing his wife in labor and the delivery of their child in a hospital with midwifery guidance.
“I couldn’t imagine how scared this patient would be, so conferencing the call was the right choice,” he states.
The call is connected and the EMD goes straight into Pre-Arrival Instructions (PAIs). Ann is sitting on the toilet. He orders her off the toilet and reaches the sequence for beginning the actual BREECH delivery instructions (and modifies them slightly from the second-party script since Ann is on her own).
In between Ann's pains, the EMD inquires about access into the house, gives words of reassurance to both parties, gives Ann instructions for pushing, and—this part is most remarkable—lets Sue coach her daughter.
Eighteen minutes into the call, the nurse arrives to find a healthy baby girl wrapped in a blanket. Paramedics enter the home moments later.
Just doing my job
I don’t want to spoil the whole story. You will have to open your issue of the AEDR and turn to page 9 to read the exciting conclusion. However, I do want to emphasize the key learning points this call clearly illustrates:
•Follow the protocol—full compliance to protocol is key.
•Be prepared to think laterally.
•We should never think we have heard it all before; in this business there will always be a call that will surprise us.
•We all have, or will have at some stage, taken a call that will leave a lasting impact on someone’s life, whether it be a successful resuscitation, a baby delivery, or just someone vomiting or an individual who has fallen and injured a hip.
We must never sell ourselves short and disregard the lasting impression our able voices and actions behind the scene imprint on callers. Our profession—EMDs, Emergency Fire Dispatchers (EFDs), and Emergency Police Dispatchers (EPDs)—casts a powerful first step into the sequence of events in any emergency situation, starting with the caller who might be trying to survive or help someone else survive the worst possible moments of their lives.
This is no easy task. Nothing about what we do is routine. We are the link that determines the strength of response.
Bacon, A. Taylor, P. An Unorthodox Delivery: “I’ve Never Done One of These Before,” Annals of Emergency Dispatch & Response. 2014; 2(1): 5-10.