Provision of neonatal and obstetric care by ambulance service

Executive summary

1. This report concerns the care provided to a woman and her baby daughter by a paramedic and St John Ambulance Service (St John). It highlights the importance of ensuring that paramedic services have adequate equipment, staff are trained adequately, and there are robust systems in place to support the delivery of safe and appropriate paramedic services to patients.
2. In 2018, the woman went into labour while travelling to hospital. She rang for an ambulance. St John attended, and the woman was transferred to the ambulance to continue on to hospital. The woman gave birth to her baby while in transit. Shortly after the baby was delivered, another ambulance officer arrived to assist with driving.
3. The paramedic assessed the baby. He documented that she cried and moved her limbs soon after being born, and although she was blue, she “pinked up within 15 [minutes]”. In contrast, the woman told HDC that the baby never cried, and was quiet and still. During the ambulance trip to hospital, the paramedic determined that the baby needed some oxygen, which was administered using the “blow-by” method.
4. The woman’s blood pressure was found to be low, and the ambulance pulled over to allow the paramedic to gain intravenous access and administer saline. On arrival at hospital, there was a delay of several minutes in the woman and her baby being transferred from the ambulance to the Delivery Suite. Oxygen for the baby was discontinued prior to her transfer to the Delivery Suite.
5. Subsequently, the baby was transferred to another district health board and diagnosed with brain damage caused by oxygen deprivation.

Findings

1. The Commissioner found the paramedic in breach of Right 4(1) of the Code for failing to undertake a complete assessment of Baby A at birth; for administering oxygen to the baby using the “blow-by” method instead of manual ventilation; and for failing to continue to provide oxygen to the baby during her transfer to the Delivery Suite. The Commissioner was also critical that the paramedic did not take a full set of vital signs when he provided treatment to the woman.
2. The Commissioner found St John in breach of Right 4(1) of the Code for the following reasons: St John did not have robust dispatch policies in place at the time of events, namely the dispatch of an ambulance was not determined by the severity of a patient’s condition, and initially the paramedic was in a single-crewed ambulance, which meant that he was cognitively overloaded having to provide care to both the woman and her baby; St John’s neonatal guidelines and training provided inadequate support for its staff in the assessment, monitoring, and treatment of newborn babies; and the ambulance was not supplied with appropriate equipment, namely a neonatal pulse oximetry probe.

Recommendations

1. The Commissioner recommended that should the paramedic return to practice as a paramedic, he undertake further training on the updated St John Clinical Procedures and Guidelines and training material related to paediatric assessment, neonatal resuscitation, and the general management of obstetric emergencies. The Commissioner also recommended that the paramedic provide a written apology to the woman.
2. The Commissioner recommended that St John consider reviewing its Guidelines to include a connection between the special considerations in young children and neonatal resuscitation; provide an update around equipping frontline and patient transfer services with neonatal-specific equipment; and apologise to the woman in writing.