2019 EMT Refresher Instructor Manual

B.4.B – Special Populations Skills/Scenario Lab Station: Emergency Childbirth Instructor Guidance Objectives: 1. Demonstrate the procedure to assist in a normal cephalic delivery. (pp 1117–1123, Skill Drill 31-1) 2. Demonstrate care procedures of the infant as the head appears. (pp 1120–1122) 3. Demonstrate the steps to follow in postdelivery care of the infant. (pp 1123–1124)

4. Demonstrate how to cut and tie the umbilical cord. (pp 1123–1124) 5. Demonstrate how to assist in delivery of the placenta. (p 1124) 6. Demonstrate the postdelivery care of the mother. (pp 1123–1124) 7. Demonstrate procedures to follow for complicated delivery emergencies including vaginal bleeding, breech presentation, limb presentation, and prolapsed umbilical cord. (pp 1112–1113, 1128–1129, 1132) Setup: - Cohort Bag - Birthing Manikin Deployment: DO NOT LECTURE – your students should be working hands-on within 5 minutes of arriving Deploy your students in one team –the instructor should be patient, the rest rescuers. Ideally this should be below clothing. Sequence: All scenarios should transition through the following: Scene Size-Up Primary assessment (airway patient, breathing labored at 22, circulation rapid at wrist, warm/sweaty skin, no bleeding) Focused assessments as below:

Run students through all the scenarios if possible. Start them all off with “your call is for woman in labor”. The patient will have an unremarkable primary assessment, with the exam items below. Students should birth the newborn and manage it as needed.

Scenario I: Non-Imminent birth

Scenario II: Imminent birth

History: 27 year old - No history. Taking prenatal vitamins and getting prenatal care. 0 previous pregnancies / 0 births. Event: Contractions began 20 minutes ago. Water broke – clear fluid. Contractions are 5 minutes apart. Exam: No crowning Decision: Transport – Simple birth happens enroute History: 29 year old - No history. Taking prenatal vitamins and getting prenatal care. 2 previous pregnancies / 0 births. Event: Contractions began 35 minutes ago. Water broke – clear fluid. Contractions are 15 seconds apart apart. Exam: Crowning (head with prolapsed cord) Decision: Immediately they should: - Push the head away from cord - Reverse tredelenberg - Administer oxygen - Transport Scenario III: Imminent birth with prolapse

History: 26 year old - No history. Taking prenatal vitamins and getting prenatal care. 2 previous pregnancies / 2 births. Event: Contractions began 45 minutes ago. Water broke – clear fluid. Contractions are 25 seconds apart apart. Exam: Crowning (head) Decision: Transport – Simple birth happens enroute History: 31 year old - No history. Taking prenatal vitamins and getting prenatal care. 3 previous pregnancies / 1 births. Event: Contractions began 45 minutes ago. Water broke – clear fluid. Contractions are 20 seconds apart apart. Exam: Crowning (head with cord around neck) Decision: Immediately they should: - Remove cord with gloved finger - Proceed with normal birth Scenario IV: Imminent birth with nuchal cord