ABSTRACTS
Describing Prehospital Maternity Care in North CarolinaAuthor: Antonio Fernandez PhD, NRP | Principal Research Scientist | ESO Associate Authors: Mitchell, Tom, EMT-P | Hood, James, A, BS, EMT-P | Treichel, Alison, MPH | Myers, J. Brent, MD, MPH | Crowe, Remle, PhD, NREMT | Wilson, Jennifer, K, MBA, EMT | Montera, Christopher, MHL, BS, NRP | Winslow, James, E, MD, MPH
Introduction In North Carolina (NC) 21% of counties are defined as maternity care deserts by the March of Dimes. These populations lack access to high-volume, high-quality care centers for certain obstetric or gynecologic procedures. However, a statewide evaluation EMS maternity care has not been performed. Objective s: Describe maternity care by Emergency Medical Services in North Carolina. Methods This retrospective study included all 9-1-1 with a provider impression or protocol documented that was consistent with pregnancy or childbirth. The study period was 1/1/2022-12/31/2024. Incident counties were identified as maternity care deserts (MCD) based on the March of Dimes categorization. Descriptive statistics were calculated. Wilcoxson Rank Sum tests and Univariable logistic regression was performed. Results During the study period, there were 5,027,518 emergency responses with 1,196 for a mother during labor and/or delivery and 34.9% (417/1,196) having a delivery procedure documented. Overall, 3.9% (47/1,196) occurred in MCDs and 2.6% (11/417) of deliveries occurred in MCDs. There was no difference in the odds of prehospital delivery in MCDs (OR: 0.56, 95%CI: 0.28-1.12, p-value=0.10). The median transport time in MCDs was 29 minutes (IQR: 23-39) while it was 15 minutes (IQR: 10-23) in areas not categorized as MCDs (p-value<0.001). There was no difference in the odds of deliveries during transport in MCD (OR: 1.36, 95%CI: 0.35-5.22, p-value=0.66). There were 7,063 remaining patients that met inclusion criteria. Of these, 3.0% (212) occurred in MCDs. The top 5 most commonly reported provider impressions in this group were: 1) Primary inadequate contractions (n=1,976), 2) Pregnancy related conditions, unspecified trimester (n=1,672), 3) Retained placenta without hemorrhage (n=563), 4) Generalized abdominal pain (n=485), and 5) Abnormal uterine and vaginal bleeding (n=387). The median transport time in MCDs was 25 minutes (IQR: 20-32) while it was 14 minutes (IQR: 10-30) in areas not categorized as MCDs (p-value<0.001). Conclusions While transport times were increased in maternity care deserts, this did not appear to lead to an increase in prehospital deliveries overall nor deliveries following patient transport. Strategies to prepare EMS clinicians to care for this patient population of low frequency high acuity calls should be investigated.
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