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INTRODUCTION: Home births have increased 77% from 2004 to 2017 and further increased with the COVID-19 pandemic. While the majority of home births are uneventful, some are complicated and require attendance of emergency medical services (EMS). Understanding characteristics of out-of-hospital births and EMS care is increasingly important to improve care. METHODS: We conducted a chart review of pediatric out-of-hospital cardiac arrests (POHCAs) from EMS agencies across the United States to evaluate the care provided by first responders. The study was approved by Oregon Health & Science University and respective IRBs. RESULTS: Of 1,020 POHCAs, 54 were responses to births and 43 were for other neonates. While most neonatal POHCAs occurred in a home or residence (84%), some births occurred at other locations such as a health care facility, public or commercial building, and street or highway. Bystander cardiopulmonary resuscitation was performed in less than half of births but more than half of other neonates. Return of spontaneous circulation was twice as likely for births as for other neonates (27% versus 13%). Overall, serious adverse safety events were observed in three-fourths of neonatal resuscitations. Births were more likely to be associated with failure to follow the correct resuscitation algorithm and lack of positive pressure ventilation. CONCLUSION: There are unique challenges in the care of out-of-hospital births for the EMS system. There is an opportunity to improve use of neonatal resuscitation protocols and early ventilation. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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BACKGROUND: The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team, but also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of PPE. METHODS: We sought to analyze the impacts of the Covid-19 pandemic on Emergency Medical Service (EMS) workers and pre-hospital care delivery. We conducted focus groups and one-on-one interviews with fire-EMS first responders between Sept 2021 and 2022. Interviews included questions about job related stress, EMS skills, work experiences and changes during Covid-19. Interviews were recorded, independently dual coded, and analyzed for themes. RESULTS: 223 first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of personal protective-equipment (PPE) was reported to have significantly impaired efficiency and perceptions of quality of care-among EMS team members and also between EMS workers and patients. EMS personnel also experienced on scene hostility on arrival (from both families and other agencies). Use of extensive PPE muffles voices, obscures facial expressions, and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone's shoulder, wearing name tags on suits, and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. CONCLUSION: Human connection is an important element of health care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider-patient interactions in pre-hospital EMS. Additionally, 'communication-friendly' adaptations of PPE equipment may be an important area for future research and development in manufacturing and the healthcare industry.