Document Type
Journal Article
Publication Title
Rural and Remote Health
Volume
24
Issue
3
Publisher
James Cook University
School
School of Medical and Health Sciences / Western Australian Academy of Performing Arts (WAAPA)
RAS ID
71753
Funders
Edith Cowan University
Abstract
Introduction: Unplanned out-of-hospital births represent less outs have a high risk of life-threatening complications, which are than 1% of ambulance requests for assistance. However, these call- particularly complex in rural or remote settings with limited accessibility to specialist care support. Many community hospitals Four themes emerged from analysis: (1) Lack of education and no longer provide obstetrics care, so birth parents must travel to exposure to birth resulted in low confidence. Most participants larger regional or metropolitan hospitals for assistance. Increased reported significant anxiety attending obstetric call-outs, and travel time may increase the risk of unplanned out-of-hospital explained under-utilisation of specific obstetric and neonatal skills birth and/or complications such as postpartum haemorrhage and meant skills decay was an issue; (2) limitations were discussed neonatal mortality. Rural volunteer ambulance officers (VAOs) are regarding VAO scope of practice and accessing medical equipment an integral component of Australia’s healthcare system, especially specifically required for birthing and neonates that could impact in regional and remote areas. Although VAO response to patient care; (3) logistical and communication difficulties were unplanned out-of-hospital births may be considered rare discussed. Long distances to definitive care, potentially limited compared to calls to other case types, provision of adequate care backup during emergencies and potential unavailability of is paramount in these potentially high-risk situations. This research aeromedical retrieval increased perceived complexity of cases. investigates Australian rural VAOs’ perceptions of their training, Telecommunication ‘black holes’ created a sense of further experience and confidence regarding unplanned out-of-hospital isolation for VAOs requiring support from senior clinicians; (4) birth and planned homebirth with obstetric emergencies where there was a perception that many members of the general public ambulance assistance is required. were unaware VAOs often staffed the local ambulance, and Methods: Semi-structured interviews and focus groups were expected VAOs to have the same scope of practice as a registered undertaken from late 2021 to mid-2023 via telephone or online paramedic. Furthermore, VAOs can attend friends and family in an videoconference. Sessions were audio-recorded and transcribed emergency, potentially creating psychological trauma. verbatim. Data were analysed and coded into themes using Braun Conclusion: VAOs report being uncomfortable attending and Clarke’s six-step process for semantic coding and reflexive unplanned out-of-hospital births and obstetric emergencies, thematic analysis. perceiving they have limited ability to manage complications. Results: Twenty-eight participants were interviewed from six Backup from a registered paramedic is dependent on availability, Australian states and territories, all of whom worked in rural and and telecommunications are not always reliable in rural areas for remote Australia. Ten participants were male, 17 female and one online clinical advice and support. Given the distances to definitive was male-adjacent, with length of VAO experience ranging from care in regional Australia, this has serious implications for patient 3 months to 29 years. Participants came from seven jurisdictional safety. Continued VAO education is essential for risk reduction in ambulance services.| out-of-hospital births.
DOI
10.22605/RRH8788
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Hill, M. G., Flanagan, B., Hansen, S., Hopper, L., & Mills, B. (2024). Out-of-hospital birth training, experience and confidence of Australian rural volunteer ambulance officers. Rural & Remote Health, 24(3). https://doi.org/10.22605/RRH8788