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Birth within the community; paramedics, OCC & intact cord resuscitation

Susan Rhind - Paramedic and Lecturer at University of Cumbria

Please welcome Susan Rhind - an operational paramedic and lecturer at the University of Cumbria. Susan's passions centre on improving care within the emergency healthcare services, and this includes helping to educate and guide clinicians in order to facilitate positive patient experience.

She is particularly passionate about improving maternity care within the ambulance service. Many of the adverse incidences within obstetric related cases are avoidable (Ledger et al., 2018) and an increase in knowledge, skill and integrated professional education provide means to equip health professionals to improve clinical outcomes and experiences for women and children in our community.


Multi-professional training

Allied Healthcare Professionals

Recently, we have seen the celebration of Allied Health Professionals (AHPs). AHPs have joined each other in appreciation of their individual roles and how they work together to improve lives of patients.

As a Paramedic and University Lecturer, I found myself holding an event bringing together midwives and paramedics to revisit the current practice surrounding emergency obstetric care in the community; the rationale to standardise knowledge and integrate care provided to women and babies following birth outside of hospital.

Multi-professional training is recognised by the Royal College of Obstetricians and Gynaecologists (RCOG, 2018), as a means to reduce mortality and morbidity during birth.

Midwifery Consultant, Amanda Burleigh was invited to the University of Cumbria to present the topic of optimal cord clamping, which has subsequently led to further discussion as to how this can be better facilitated by paramedics when supporting birth within the community.

Ambulance services have revisited guidelines surrounding cord-clamping following uncomplicated births and these guidelines are reflected in an update provided by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) in 2017, with a secondary extension published in 2018 providing additional resources on managing birth in the community.

Blood loss management

This approach isn’t unique; ambulance trusts have sought guidance from multiple sectors previously to inform clinical practice, and this can be seen with an inclusion of evidence to support practice around major trauma or extreme blood loss management, now considered an integral paramedic skill.

This aspect that has had multiple reviews in recent years, and it is well-recognised that the ability to prevent further blood loss is paramount to patient survival and that outcomes from blood loss remain poor (Panteli, et al., 2015). With this is mind, tourniquets were reintroduced, and subsequently haemostatic dressings are now standardised agents to manage heavy blood loss.

The importance of controlling bleeding is highlighted when the heavily indoctrinated ABCDE assessment approach was changed to include the priority of haemorrhage control in the first instance. cABCDE, now provides emphasis on haemorrhage control over airway or breathing (Natio