Bringing Out Baby

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You may or may not be aware that the International Academies of Emergency Dispatch^® (IAED^™) has recently re-formed its High Risk Obstetrics Council. This revival is part of a larger effort to ensure that the questions and instructions provided on Protocol 24: Pregnancy/Childbirth/Miscarriage, Protocol G: Miscarriage, and Protocol F: Childbirth – Delivery continually evolve; remain clinically safe; and act in the best interest of women, babies, and their families.

“We had a longstanding council, but attrition from retirement and other reasons started taking their toll,” Brett Patterson, Academics and Standards Associate and Medical Council of Standards Chair, said. “Towards the end, we had more emergency physician representatives than obstetric specialists, and this was concerning."

One of the factors leading to this council’s revitalization was an uptick of interest in midwifery in the United Kingdom (UK) and midwives reaching out to the IAED about changing standards of practice. The UK’s National Health Service (NHS) appointed Professor Jacqueline Dunkley- Bent as their very first Chief Midwife in spring of 2019 “to oversee delivery of a package of measures building on increased safety and support in maternity care.”¹ As of January 2024, the number of nurses and midwives working in the NHS in England was 372,411, the number of midwives having grown by 1,000 from the previous year.²

This expansion of the profession resulted in more experts being added to the High Risk Obstetrics Council. Members included Patterson and Bethan Jones, Specialist Clinician Remote Care (Maternity) with the Welsh Ambulance Services University NHS Trust (WAST), as well as two obstetricians, a physician researcher, three midwives, and a consulting neonatologist.

“When I first started in WAST, I was really interested in the control room and understanding the ‘why’ behind the protocols,” Jones said. “Feedback from staff was that Protocol 24 was the most difficult protocol to navigate, and after going through the protocol myself, I became really interested in making it easier for them and making the instructions better quality for the women and babies we were serving.”

In preparation for its first in-person meeting with the new members at the 2023 UK & Ireland NAVIGATOR held in Cardiff, Wales, Jones gathered evidence on important topics such as postpartum bleeding, umbilical cord care, and neonatal hypothermia and printed out booklets for all the attendees. The group then reviewed Protocol 24 to make sure everything was as up to date as possible with the latest research and professional standards of care, making changes where necessary.

“When we first created this protocol, we started with nine panels,” Patterson said. “There are 36 today. Protocol 24 is unique because unlike every other protocol, it’s not dispatcher-driven. It’s patient-driven. You have to really know the protocol and move around at mom and baby’s pace.”

Hypothermia
One of the main objectives of Pre- Arrival Instruction (PAI) Protocol F is simple—keep the baby warm. A research study conducted in Brazil found that the “presence of hypothermia soon after birth was the main contributor to hypothermia at NICU admission, which increased the chance of early neonatal death by 64%.”³ This is especially important with prematurely born infants, and Brazil isn’t the only country where such studies were conducted.

“A study conducted by Dr. Laura Goodwin found that babies were the coldest when the ambulances finally get to the scene,” Jones said. “By the time an EMD gets to the point of the protocol where they need to instruct the caller to keep the baby warm, their bandwidth is completely used up. We added specific instructions so they didn’t have to think about it.”

Dr. Goodwin, an Associate Professor in Emergency Care at the University of the West of England (Bristol) and a member of the IAED’s High Risk Obstetrics Council, collaborated with the South Western Ambulance Service NHS Foundation Trust, gathering data from the southwest of England over a three-year period, finding that roughly 3,700 babies in the UK are born in a prehospital setting every year. These newborns experience poorer health outcomes when compared to their counterparts who are born in a hospital. During this three-year period, only 2.7% of babies had their temperature measurements recorded when the paramedics arrived on scene. Of that 2.7%, a staggering 72% were hypothermic on arrival at the hospital.⁴

“We were blown away by the increase in mortality by the degree in temperature,” Patterson added.

This research highlighted that when a woman unexpectedly gave birth, general advice such as “keep your baby warm” isn’t sufficient. The protocol was therefore revised to include clear, step-by-step instructions, ensuring callers know exactly how to keep the newborn warm in these stressful situations. Updates to Panel F-8 have you instruct the caller to remove any wet clothing from the mother’s belly and place the baby directly on her skin, covering the baby’s head with an infant cap, hat, blanket, or towel—but not its face. Additional instructions have you tell the caller to warm the room by closing or opening windows, turning on heaters, and turning off any fans. Previous versions simply stated to “keep the baby warm,” while this update specifies how to keep the baby warm. It might seem like a small change, but when there are specific instructions written out, they don’t get missed no matter how stressful the situation.

Due date calculator
There’s a new calculator function in Protocol 24 designed to enhance efficiency and accuracy. Recognizing that expectant mothers and their partners typically recall due dates rather than the duration of the pregnancy in weeks or months, ProQA^® now automatically calculates gestational age based on the due date entered by the EMD. This streamlines the process and allows for more precise and relevant questioning tailored to specific weeks of pregnancy, eliminating the need for manual calculations. The transition from generic instructions to more detailed protocols also supports better decision-making under pressure, reducing the risk of errors during high-stress situations.

“Colleagues in London have given the feedback that this has been a positive change,” Jones said.

Multiple births
While a baby delivery call might be rare, a delivery with more than one baby is even rarer. In the versions of Protocol 24 that came before v14, it was cumbersome to go back in the sequence after the first one was delivered. Now there are new buttons (F-13 and F-14) that return the EMD to the start of the instructions (F-4) for the second baby after securing the health and safety of the first baby. While not a change to the content of the protocol, it’s important to the IAED that ProQA enhances your abilities by being as easy to use as possible.

Upcoming changes
The High Risk Obstetrics Council meets regularly, and some topics they were considering at their most recent meeting in December 2025 were deciding on a DLS-specific definition of “neonate” since it varies in medical literature; a sub-Chief Complaint for “lack of fetal movement”; a revisitation of CPR techniques for pregnant patients; better or continued confirmation of breathing of the baby after birth; and a sub-Chief Complaint and instructions for people having taken the morning-after pill or abortion pill and are experiencing adverse side effects. Look out for these and similar updates in the Spring 2026 release and in the future!

As ever, many of the changes that are made to the MPDS come from user feedback. As an EMD, you are using the protocols day in and day out, and if you do run into any complications or confusion, you can send a Proposal for Change (PFC) to the IAED’s Council of Standards.

“The feedback you get while sitting with the dispatchers cannot be overstated,” Jones said.

Sources
1. “First Chief Midwife appointed to drive world-class NHS care for new mums.” NHS England. 2019; March 14. england.nhs.uk/2019/03/first-chief-midwife-appointed (accessed Dec. 3, 2025).

2. “Record number of nurses and midwives working in NHS.” NHS England. 2024; Jan. 25. england.nhs.uk/2024/01/record-number-of-nurses-and-midwives-working-in-nhs (accessed Dec. 3, 2025).

3. de Almeida, M.F.B., Guinsburg, R., Sancho, G.A., et. al. “Hypothermia and early neonatal mortality in preterm infants.” The Journal of Pediatrics. 2013; Nov 8. jpeds.com/article/S0022-3476(13)01220-1/abstract (accessed Dec. 3, 2025).

4. Media Relations Team. “Health services respond with changes after research reveals chance to improve temperature checks in prehospital births.” UWE Bristol. 2024; Feb 1. uwe.ac.uk/news/research-into-out-of-hospital-births-leads-to-improved-working-practices (accessed Dec. 3, 2025).