Frequency and severity of prehospital obstetric events encountered by emergency medical services in the United States

Rebecca E Cash,Anjali J Kaimal,Carlos A Camargo,Margaret Samuels-Kalow,David Eisenbrey,Robert A Swor

doi:10.1186/s12884-021-04129-1

Abstract

BackgroundPrehospital obstetric events encountered by emergency medical services (EMS) can be high-risk patient presentations for which suboptimal care can cause substantial morbidity and mortality. The frequency of prehospital obstetric events is unclear because existing descriptions have reported obstetric and gynecological conditions together, without delineating specific patient presentations. Our objective was to identify the types, frequency, and acuity of prehospital obstetric events treated by EMS personnel in the US.MethodsWe conducted a cross-sectional analysis of EMS patient care records in the 2018 National EMS Information System dataset (n=22,532,890). We focused on EMS activations (i.e., calls for service) for an emergency scene response for patients aged 12-50 years with evidence of an obstetric event. Type of obstetric event was determined by examining patient symptoms, the treating EMS provider’s impression (i.e., field diagnosis), and procedures performed. High patient acuity was ascertained by EMS documentation of patient status and application of the modified early obstetric warning system (MEOWS) criteria, with concordance assessed using Cohen’s kappa. Descriptive statistics were calculated to describe the primary symptoms, impressions, and frequency of each type of obstetric event among these activations.ResultsA total of 107,771 (0.6%) of EMS emergency activations were identified as involving an obstetric event. The most common presentation was early or threatened labor (15%). Abdominal complaints, including pain and other digestive/abdomen signs and symptoms, was the most common primary symptom (29%) and primary impression (18%). We identified 3,489 (3%) out-of-hospital deliveries, of which 1,504 were preterm. Overall, EMS providers documented 34% of patients as being high acuity, similar to the MEOWS criteria (35%); however, there were high rates of missing data for EMS documented acuity (19%), poor concordance between the two measures (Cohen’s kappa=0.12), and acuity differences for specific conditions (e.g., high acuity of non-cephalic presentations, 77% in EMS documentation versus 53% identified by MEOWS).ConclusionPrehospital obstetric events were infrequently encountered by EMS personnel, and about one-third were high acuity. Additional work to understand the epidemiology and clinical care of these patients by EMS would help to optimize prehospital care and outcomes.

Highlights

Prehospital obstetric events encountered by emergency medical services (EMS) can be high-risk patient presentations for which suboptimal care can cause substantial morbidity and mortality
We excluded activations for a non-emergency response; where the response was cancelled without patient contact or no patient was found on scene; if the patient was outside of the specified age range; or if the record had no indication of an obstetric complaint or pregnancy
Measures We identified an EMS emergency activation involving an obstetric complaint based on one or more of the following: dispatch reason; primary and secondary symptoms documented by the treating EMS provider; the EMS provider’s primary and secondary impressions of the patient’s complaint; procedures performed by EMS; and the EMS provider’s documentation of the clinical protocol under which they provided care (Table S1)

Summary

Introduction

Prehospital obstetric events encountered by emergency medical services (EMS) can be high-risk patient presentations for which suboptimal care can cause substantial morbidity and mortality. Our objective was to identify the types, frequency, and acuity of prehospital obstetric events treated by EMS personnel in the US. Current national estimates of the frequency of these events do not differentiate between gynecological and obstetric complaints [2,3,4], nor are the specific conditions treated most commonly by EMS personnel known. Evidence from other countries suggests that obstetric events, including events like unplanned out-of-hospital delivery or post-partum hemorrhage, are low frequency but potentially high-risk patient presentations. A better understanding of the acuity of patients presenting with obstetric conditions would enable improved EMS planning and training

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