Board 199 - Program Innovations Abstract The Birth of Collaborative Emergency Vaginal Delivery and Infant Stabilization Training

Abstract

Introduction/Background Vaginal delivery in a helicopter is an unpredictable and uncommon emergency. In obstetrics there are at least two patients to care for instead of one. The management of one patient heavily affects the management of the other. A healthcare provider’s ability to react prudently in an unexpected situation is one of the most critical factors in creating a positive outcome in an obstetrical emergency. This Emergency Delivery pilot curricula prepares the Life Flight and Maternal Transport teams how to successfully manage this rare, unpredictable obstetrical emergency together through simulated training experiences that pose no risk to mother and infant. The Life Flight helicopter air-medical transport system was established at OSF Saint Francis Medical Center in June 1984. A Maternal Transport Team dedicated to the care and transport of high-risk pregnant women was established in 1986. These two teams come together to transport mothers with perinatal complications or those at risk for premature delivery to a hospital that can provide a higher level of care. The crew configuration for obstetric transports includes one Maternal Transport Registered Nurse and one primary Life Flight Registered Nurse or Paramedic. There has never been collaborative emergency delivery training between the Life Flight and Maternal Transport crews. Methods A pre-test of 30 questions to document the learners’ knowledge of emergency delivery will be administered. The reference population for this collaborative includes 21 Life Flight Nurses, 1 Paramedic and 15 Maternal Transport Nurses. The didactic segment includes five e-Learning modules. These modules review strategies for emergency vaginal delivery management, correct application of interventions to manage vaginal delivery complications, infant stabilization and relevant team communication tools. Completion of the Emergency Delivery e-Learning will be a requirement prior to participation in an actual helicopter in-situ simulation. Using a standardized patient wearing a partial obstetrical task trainer, the aim of the simulation component will be to analyze the crews performance using real-life emergency delivery scenarios, detect areas of deficiency and initiate performance improvements that will transfer to applied clinical practice. Each simulation will include one Life Flight, one Maternal Transport crew and one standardized patient. Results: Conclusion Cognitive skills from the didactic will be measured by comparing the identical 30 question pre-test knowledge of emergency delivery/infant stabilization to the identical 30 question post-test knowledge after the simulated training intervention. A number value of one will be assigned to each question. Technical skills will be measured by using the Emergency Delivery checklist of 11 clinical vaginal delivery maneuvers. Infant stabilization will be evaluated using the Infant Stabilization checklist of 11 infant stabilization maneuvers. Each maneuver in the checklist will be evaluated as either present or absent. Through debriefing following each simulation, the focus will be on detected deficiencies that have remained undiscovered due to the fact that this collaborative training has never taken place before. Video playback of each simulation will be used. Behavorial skills will be measured by assessing the participant’s level of confidence in dealing with emergency vaginal delivery and infant stabilization. The pilot program participants will be given a survey measuring their level of confidence both prior to and at the Conclusion of their in-situ helicopter simulation. The Visual Analog Scale will be the metrics used to measure both the preceived pre-simulation and post-simulation confidence of the15 question survey. Evidence based guidelines exist for safe vaginal delivery practices. The challenge is to ensure these guidelines are applied to every patient every time, regardless of whether this delivery occurs inside a hospital or enroute to a hospital. Disclosures None.