Abstract
ObjectiveEmergency medical service (EMS) is responsible for prehospital care encompassing all ages, irrespective of injury cause or medical condition, which includes peripartum emergencies. When patients require care more advanced than the level provided by the national EMS protocol, an EMS physician-staffed Dutch helicopter emergency medical service (HEMS) may be dispatched. In the Netherlands in 2016, there were 21.434 planned home births guided by midwives alone without further obstetric assistance, accounting for 12.7% of all births that year. However, there are no clear data available thus far regarding neonates requiring emergency care with or without HEMS assistance. This article reviews neonates during our study period who received medical care after birth by HEMS. MethodsA retrospective chart review was performed including neonates born on the day of the dispatch between January 2012 and December 2017 who received additional medical care from the Rotterdam HEMS. ResultsFifty-two neonates received medical care by HEMS. The majority (73.1%) were full-term (Gestational age > 37 weeks). Home delivery was intended in 63.5%, 20% of whom experienced an uncomplicated delivery but had a poor start of life. The majority of unplanned deliveries (n = 17) were preterm (70.6%). Two were born by resuscitative hysterotomy; 1 survived in good neurologic condition, and the other died at the scene. Fifteen neonates (28.9%) required cardiopulmonary resuscitation; in 2 cases, no resuscitation was started on medical grounds, and 12 of the other 13 resuscitated neonates regained return of spontaneous circulation. In 33 (63.5%) of the neonates, respiratory interventions were required; 8 (15.4%) were intubated before transport. Death was confirmed in 5 (9.6%) neonates, all preterm. ConclusionDuring the study period, 52 neonates required medical assistance by HEMS. The 5 infants who died were all preterm. In this cohort, adequate basic life support was implemented immediately after birth either by the attending midwife, EMS, or HEMS on arrival. This suggests that prehospital first responders know the basic skills of neonatal life support.
Highlights
MethodsThis study was a retrospective database review of the Rotterdamhelicopter emergency medical service (HEMS), which included all patients born on the day of the dispatch between January 2012 and December 2017
From the patients not deceased during the initial assessment by the helicopter emergency medical service (HEMS) crew, we requested the information from the Dutch register of the “Gemeentelijke Basis Registratie” (GBA) registering all citizens by name, sex, date of birth, and, if applicable, date of demise
We found in the HEMS charts that when Basic life support (BLS) was started immediately by the first responder, the situation was considerably different compared with a study of unplanned prehospital deliveries in Texas where up to 75% did not receive any resuscitative interventions at all, such as oxygen or bag mask ventilation, until they reached the hospital, resulting in more cardiopulmonary arrests.[2]
Summary
This study was a retrospective database review of the RotterdamHEMS, which included all patients born on the day of the dispatch between January 2012 and December 2017. Deployments canceled before the HEMS crew had seen the patient are excluded from this database. The charts were reviewed on patient demographics, (estimated) gestational age, (estimated) birth weight, prehospital interventions, and, if available, hospital follow-up and mortality. From the patients not deceased during the initial assessment by the HEMS crew, we requested the information from the Dutch register of the “Gemeentelijke Basis Registratie” (GBA) registering all citizens by name, sex, date of birth, and, if applicable, date of demise. This information was obtained on June 18, 2018. All data were analyzed using descriptive statistics with SPSS Statistics Version 24.0.0.1 (IBM Corp, Armonk, NY)
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