June 12, 2014
By Audrey Fraizer
Stefana Dershko has a naturally calming influence.
Someone could be trapped in a car following an accident, trying to control bleeding after a fall, or—as in the most recent incident—assisting in a breech delivery, and she is at her ultimate comfort level giving instructions.
Dershko likes people. She likes figuring them out, even if it’s only by listening to their voices. She likes knowing she has the knack to help during an emergency. While it might be the pitch of a roller coaster rush when things go well, it’s also gratifying to know she can affect a smooth ride.
As an EMD, she’s in the profession that she’s supposed to be.
“We definitely receive the training to do this,” said Dershko, an EMD with the Toronto Emergency Medical Services (EMS) Communications Centre in Ontario, Canada. “But it also takes the ability to relate to people. We have to get our callers to trust us.”
The trust was running strong on both ends of the phone on Dec. 6, 2013, when Dershko took one last call before her shift ended. The caller, David Bennett, said his wife, Liz Maier, was in active labor. Her water had broken, and in the rush to the hospital, she had made it from their bedroom to the foyer. She wasn’t going any farther.
Bennett didn’t know exactly how far along his wife’s labor had progressed, although the baby, the couple knew, would be breech. Doctors had monitored Maier weekly during the pregnancy, which was considered high risk because of the baby’s known fetal position. The baby’s breech position had alternated among the variations (frank breech, complete breech, lotus breech, and footling breech) over the last trimester.
Seconds into the call, Bennett reported that the baby was indeed visible, although, as expected, not head first.
“He saw a foot,” Dershko said. “The baby was breech.”
This was Dershko’s first-ever over-the-phone delivery. She had been an EMD with Toronto EMS since September 2013.
Dershko followed protocol and began giving Pre-Arrival Instructions (PAIs) for a breech delivery. She relayed to the caller “exactly what to do next.”
The birth was going as well as can be expected in a footling breech, which is considered the most precarious breech position because of the higher chance of cord prolapse.
“The father was so calm,” Dershko said. “He and his wife were totally focused and did exactly what they should be doing in this type of situation. They were both fantastic.”
A particularly distressing complication came minutes into the delivery.
The baby’s head was wedged inside the birth canal, which is an inherent risk of a footling breech. Delivery of the feet through an incompletely dilated cervix can lead to arm or head entrapment and obstruct the umbilical cord.
Rescue arrives at the door
In the background, Dershko heard the couple’s two other children, ages 3 and 5, excitedly announce the arrival of the first responders.
Dershko stayed on the line when the firefighters arrived and continued to provide PAIs to the firefighter who took over the phone call. A few short minutes later Toronto EMS paramedics Ornella Guizzo and Michael Toliver arrived and completed delivery.
The first signs were unnerving. The umbilical cord had wrapped tight around the baby’s neck and the baby was born without vital signs.
Dershko left work understandably anxious about the outcome and stopped her car by the side of the road when her cellphone rang. It was the Toronto EMS Communications Centre.
“She pinked up in the ambulance,” Dershko said. “It was such good news. I was very relieved.”
Six weeks later, a coincidental connection made a visit to Toronto EMS headquarters possible, said Maier, who had been determined to say thank you from the day of baby Stephanie’s birth. Although Maier didn’t remember much from the actual 10-minute ordeal, she clearly recalls her husband’s calming voice, the firefighters and paramedics, and fragments of conversation swirling around her.
“I could hear the paramedic [Guizzo] saying, ‘Come on, beautiful. Come on,’” Maier said. “Then I heard a cry. It was our baby. That’s it, except for looking up at the four gorgeous firefighters and four equally gorgeous paramedics standing in my foyer.”
Maier was determined to thank everyone involved. But there were obstacles relating to patient and personnel confidentiality. Toronto EMS could not release the names of the dispatcher or responders.
A thank you relayed over the phone might have been the “end of story” had it not been for the surprise baby shower hosted by Maier’s office one week later. In the “small world” kind of way that things sometimes happen, Dershko’s Toronto EMS dispatch trainer, David Neave, and Maier’s boss had stayed buddies since high school. Following a few calls, a visit to Toronto EMS headquarters to meet everyone involved was arranged.
“I hugged everybody,” Maier said. “I am so grateful for everything they did. A few more seconds and this would have ended in a very different way.”
Dershko was genuinely pleased to meet the family. She had her photo taken with Maier and Bennett, and described the use of PAIs.
Toronto EMS Chief Paul Raftis presented Dershko, Guizzo, and Toliver with stork pins, an honor paramedics and emergency medical dispatchers receive after assisting in the delivery of a baby. Paramedics used a mannequin to demonstrate the maneuver they used to free the baby’s head for a prompt delivery.
“They were really, really a nice family,” Dershko said. “Mom gave us all big hugs. They knew how close they came in losing the baby. It was great being part of this.”
The enthusiasm of her brother-in-law and sister for 9-1-1 piqued Dershko’s interest in the profession and that, along with the knowledge that she’s the type who responds well in an emergency, convinced her to pursue the job.
Dershko also had another reason. She was motivated by a call—or rather the response to a call—she made to 9-1-1 years ago when her grandfather died.
“If I could make someone feel the same way [the dispatcher] helped me, I knew that’s what I wanted to do,” Dershko said. “I’m thrilled to be here. This is the last job I’ll ever have, and I’m happy to say that.”
Toronto EMS Communications Centre processes about 263,600 calls per year and responds to approximately 750 per day. They deliver more than 50 babies a year out-of-hospital.