Newborn Resuscitation

Brett Patterson

Brett:

I had this inquiry from a senior midwife [Suzie Dunstan].

Having recently been asked to listen in to a call where an EMD was giving resuscitation advice to a parent resuscitating a newborn baby, I became aware that your EMD Protocols differ from the International Liaison Committee on Resuscitation (ILCOR) Guidelines.

The ILCOR advise a rate of 3:1 whilst the EMD Protocol is 5:1.

I understand from one of your paramedic staff here that there is also a difference between the ILCOR Guidelines and the EMD in the ratio for resuscitating children.

Many thanks.

Suzie Dunstan

Senior Midwife

Plymouth Hospitals NHS Trust

Plymouth, England

Any comments [Dr. Andy Smith]?

From what I can see:

MPDS®                                                                                   

Newborn / neonate < 30days                     1:5 ratio of breaths to compressions

Infant < 1yr                                                           2:30

Child 1–7yr                                                           2:30

Adult > 8yr                                                           2:30

ILCOR Pediatric BLS

All providers should be encouraged to initiate CPR in children even if they haven’t been taught specific pediatric techniques. CPR should be started with the C:V ratio that is familiar, and for most, this will be 30:2. The pediatric modifications to adult CPR should be taught to those who care for children but are unlikely to have to resuscitate them. The specific pediatric sequence incorporating the 15:2 ratio is primarily intended for those who have the potential to resuscitate children as part of their role.

The recommended compression to ventilation ratio for CPR remains at 3:1 for newborn resuscitation.

Kind regards,

Dr. Andy Smith

Executive Medical Director

South Western Ambulance Service NHS Foundation Trust

Exeter, U.K.

Greetings Dr. Smith:

You are correct. The ILCOR Guidelines address untrained laypersons, trained laypersons, and various providers—there has been very little mention of dispatch pre-arrival instructions until recently. The International Academies of Emergency Dispatch® closely evaluates these published guidelines and “translates” them to the non-visual realm of dispatch. The Academy has a special Obstetrics Council that considers childbirth and neonatal care.

While trained rescuers are taught to provide a 3:1 compressions to ventilations ratio for neonates using the encircling hand/double thumb compressions technique, without the classroom training, this technique is not practical for the untrained rescuer in a non-visual environment. Not only is it difficult to instruct and understand in the emergent and non-visual environment, it is difficult to carry out with a single rescuer without very significant pauses in compressions.

There are as many differences between DLS (Dispatch Life Support), trained layperson first aid, and BLS, as there are between BLS, ALS, and in-hospital care, most commonly because of the non-visual nature of our practice, and also because of the inherent lack of time to train in an emergent situation.

You may be interested in some of the dispatch-specific articles on the IAEDwebsite under the Science tab (emergencydispatch.org) and articles on aedrjournal.org.

Please let me know if I can be of any additional assistance.

Brett A. Patterson

Academics & Standards Associate

Chair, Medical Council of Standards

International Academies of Emergency Dispatch (IAED)

 

Brett:

We are configuring our ProQA® in preparation to upgrading from v13.0 to v13.1 and got a little confused with protocol 24-A-1. Under Determinant Descriptor, it states, “Omega protocol only: 1st TRIMESTER hemorrhage or MISCARRIAGE without 1st party verification -> 1st TRIMESTER hemorrhage / MISCARRIAGE without 1st party verification.”

The change from “or” to “/” is clear enough, but we don’t understand the “Omega protocol only” part.  Shouldn’t anything that is an Omega be “O,” as in 24-O-x?

I’d also like to confirm that the only changes/adds are to protocols 12, 23, and 24? Are we missing some or are there really just these few?

Thank you for your time.

Michael Dickerson

Supervising Public Safety Dispatcher

Ventura County Fire Department

Camarillo, California, USA

Hi Michael:

The OMEGA Protocol is actually another version of the MPDS® that has additional OMEGA codes, most of which are ALPHA-Level codes in the MPDS. The OMEGA protocol version is used in centers that have referral endpoints established, are accredited, and have chosen to use the OMEGA version. When we do updates, we need to include those minor differences to cover both protocols.

And yes, v.13.1 is a limited release in ProQA only. Due to lengthy production times, the Academy will now be releasing smaller updates on a more frequent basis. In that way we can prioritize the changes and be more responsive.

Brett

Brett:

My EMD-trained dispatch student inquired how to approach a medical call from a woman who was assigned a male at birth or man who was assigned a female at birth.

Many EMD questions, Protocols, and PDIs are obviously gender/sex specific, e.g. pregnancy. Do you question/address the caller as per their actual physical gender or by their preferred sexual identity?

Stephan Bunker

Maine E911 Advisory Council and PDC Instructor

Hi Stephan:

The Academy reached out to three transgender advocacy groups in an attempt to address this question, and we received one detailed reply. Unfortunately, this is a complicated issue due to the various surgical/hormonal stages an individual may be in at the time of an emergency call. So the long and short of it is we decided not to “protocolize” the issue due to the potential variance.

The good news is that there are some constants. First of all, refer to the patient based on how they identify. This is very important, no matter what the patient’s clinical state is. The biggest difference between gender in the MPDS is the use of she versus he, so identity becomes key here.

Fortunately, with the exception of pregnancy (specifically, questions qualified by childbearing age range), the protocols’ clinical differences are primarily related to cardiac age range, and this difference is relatively subtle in the MPDS and not likely to be an issue when using the patient’s birth sex. And with regard to pregnancy, it is appropriate to ask questions qualified by “female” when the patient’s birth sex is female, as these questions do not ask directly about pregnancy and are in no way offensive to someone identifying as male.

The only potential conflict I can see is a female born patient who identifies as male complaining of abdominal pain. By Rule, abdominal pain during pregnancy should be considered contractions until proven otherwise. But even this should not be problematic because pregnancy needs to be offered in this scenario; the protocol does not ask if the female patient in childbearing age range is pregnant because of the historical inaccuracy of the answer provided. In other words, pregnancy needs to be offered by the caller before this Rule applies, and if the patient offers pregnancy, the Rule does apply.

So, in summary, use the patient’s birth sex for protocol interrogation but always respectfully refer to the patient by gender identity.

Thanks for the question.

Brett

ABOUT THE AUTHOR:
Brett A. Patterson is an Academics & Standards Associate and Medical Council of Standards Chair for the IAED.

 

 

 

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