Standards Procedure (Skill)
Clinical Indications: Levels: EMT-B, EMT- D,
EMT-I, EMT-P
Ø Imminent delivery with crowning present.
Procedure:
a. Gather and prepare all necessary equipment.
b. Confirm the presence of crowning by assessing the vaginal are during a contraction.
c. To prevent injury to the infant and mother, a slow controlled delivery is recommended.
d. Support the infant’s head as needed and allow a natural delivery.
e. Check the neck for presence of the umbilical cord. If present attempt to gently slip over the face of the infant, if unable to do this clamp the cord in two places and carefully cut between the clamps.
f. Suction the infant’s mouth and nose with a bulb syringe and dry the head of the infant.
g. During the next contraction gently guide the infant’s head down to allow the delivery of the anterior shoulder. Then gently guide the head up to allow the delivery of the posterior shoulder.
h. Slowly deliver the rest of the infant.
i. Continue to suction and dry the infant and provide tactile stimulation to promote crying.
j. Clamp the cord approximately 8-10 inches from the infant’s umbilicus and then place second clamp 2-3 inches back toward the umbilicus. Avoid “milking” the umbilical cord.
k. Cut the cord between the two clamps and observe for uncontrolled bleeding from either end, if present apply additional clamps as necessary to control bleeding.
l. Record the APGAR scores at 1 and 5 minutes.
m. Follow the New Born Protocol for further treatment.
n. The placenta will deliver simultaneously (5-20 minutes after birth of infant), avoid pulling on the cord to deliver placenta. Place placenta in a bag and transport with mother and infant.
o. Massaging the uterus may facilitate the delivery of the placenta and decrease maternal bleeding by allowing the uterus to contract.
p. Continue rapid transport to the hospital.
q. Document procedure, results, findings and time on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.