Expecting the unexpected: Transport team training for high-risk pregnancy transports

UCHealth’s northern Colorado transport team adds obstetrics to list of skills
April 26th, 2016

Pregnant women who need emergent care may be able to deliver closer to home now that UCHealth’s northern Colorado critical care transport team has added obstetrics to its list of skills.

Members of UCHealth’s critical care transport team, which includes both ground and air services, have undergone special training to transport expecting mothers — mostly from rural Colorado, Wyoming and Nebraska — to the closest hospital providing the level of neonatal care they’ll require.

“We often get calls for transfers from smaller hospitals in surrounding communities or from freestanding emergency rooms for a pregnant woman who, for example, is in early labor or having other complications,” said Geraldine Tamborelli, senior director of UCHealth’s Women and Children services in northern Colorado.  “This new program allows us to answer those calls.”

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Air Link Flight Paramedic Kris Schott learns how to feel for a baby as part of recent training. UCHealth Northern Colorado’s critical care transport team has added obstetrics to their list of skills and will be able to start transporting high-risk pregnant women this summer. Photo by Kati Blocker, UCHealth.

Although PVH EMS Critical Care Transport Service is currently the only ground transport program in northern Colorado that provides patients ICU-level care while traveling between hospitals, it wasn’t staffed to handle high-risk pregnancies. Same was true with UCHealth’s Air Link helicopter transport program. This meant that many pregnant women with emergency needs were being transported by Denver-based services to Denver-based hospitals.

“We have emergency and critical care training, but when we deal with OB it tends to be more of the emergency delivery cases,” said Duane Rorie, Air Link charge nurse. “With the new program, we’ve obtained the skills specific to these cases, and the pregnancy won’t be the secondary issue we’re dealing with but the first.”

UCHealth will kick off its OB Transport Program this summer.

Members of the program include Air Link, the critical care ground transport team and OB nurses. While the OB nurses learned how to maneuver in the tight quarters of a moving unit, ground transport and Air Link flight crew spent time learning the ropes of the labor and delivery floor — even taking advantage of UCHealth’s relationship with Children’s Hospital Colorado and getting specialized training there.

“Delivering babies can be scary,” Rorie said. “It’s a very specialized unit and care, and being able to be hands on with those high-risk patients was great training.”

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Members of UCHealth’s Critical Care Ground Transportation Program and Air Link Flight Team learn how to use their new fetal monitor with help from Tracy McGuire, clinical nurse educator with UCHealth’s birthing center, and two pregnant volunteers. Photo by Kati Blocker, UCHealth.

But Tamborelli said the two specialties have more in common than one might think. “OB nurses are a lot like EMS and ER nurses — they deal with a lot of emergencies, blood and other issues.”

Gary Davis, who has OB transport experience and now is a flight paramedic with Air Link, said the training was great for those new to an OB program but also a very useful review for experienced OB medics.

“I’ve been part of high-risk OB transports for many years,” he said. “What we learn helps us decide how to safely transport the mother to the receiving hospital without delivering, because our goal is not to deliver that baby in the aircraft.”

With this goal in mind, the crew learns how to monitor the mother and baby with their new high-tech fetal monitor, how to know when the baby is in distress and how to treat the mother in those situations. Although they are working with medications and equipment that’s always been onboard, they can now use them in high-risk pregnancy situations. The fetal monitor is the only new equipment but an extremely important piece, Davis stressed.

“It’s a bunch more squiggly lines that we have to make sense of, but how they all work together is how we optimize the health of both mom and baby so that we can make the transport as safe as possible,” he said.

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Tracy McGuire, clinical nurse educator for UCHealth birthing center, teaches UCHealth flight nurse Dave Steiner and flight paramedic Kris Schott how to place a fetal monitor on a pregnant patient. Photo by Kati Blocker, UCHealth.

A pregnancy is considered high risk when there are potential complications that could affect the mother, baby or both. These cases usually require special management and monitoring to ensure best outcomes. The OB transport team may receive transport requests for mothers who have pre-eclampsia or signs of premature labor (labor before 37 weeks of pregnancy). They may also be transporting a pregnant woman with multiples or placenta previa, another concerning condition.

Poudre Valley Hospital in Fort Collins is a Subspecialty Care Level III Maternity Center, meaning that it can care for women carrying babies of gestational age greater than 28 weeks. It can accept women who are 27 weeks pregnant on a case-by-case basis with consultation from the neonatologist. The maternity center also is equipped to care for pregnant women who are diabetic, have adult respiratory syndrome, are in preterm labor, are having multiples or are pre-eclamptic.

Medical Center of the Rockies in Loveland is a Level II center and accepts patients with similar symptoms, but their babies must be at a gestational age of 34 weeks or greater — 35 weeks or greater for twins.

Along with en route care, the OB training enhances the services these nurses and medics can provide in trauma cases, Rorie explained.

“Now when we arrive on scene, we can take care of a patient’s pregnancy along with the trauma that we were called in for,” he said. “It’s another level of care we can provide that improves our service and patient outcomes.”