Docstoc

Maternity Ambulance final report

Document Sample
Maternity Ambulance final report Powered By Docstoc
					EMERGENCY AMBULANCE
  SERVICES SURVEY




 Re: MATERNITY CARE SERVICES




                      Prepared by:

 Canterbury West Coast Emergency Care Co-ordination Team

                       2005 - 2006
INDEX
  Introduction                                               3



  Recommendations                                            4



  Survey Results           A: Service Specifications         5



                           B: Emergency Situations           7



                           C: Specific Incidents             17



  Contributing Responses   SouthComm                         23



                           St John Operations                24



                           St John Clinical Education Unit   25



                           New Zealand College of Midwives   26
                           Canterbury / West Coast Region


  Acknowledgements                                           32




                                   2
EMERGENCY AMBULANCE SERVICES SURVEY

FINAL REPORT

RE: MATERNITY CARE SERVICES

The Canterbury / West Coast is one of five ECCTs throughout New Zealand that is required to promote the
implementation of the Ministry of Health’s Roadside to Bedside strategy. The requirements of this strategy
which affect maternity care providers and emergency ambulance services include:

               Promotion, assessment and improvement of services for the transport, reception and
                treatment of seriously ill maternal and newborn clients
               Monitoring the provision of emergency services
               Monitoring the provision of education and training in emergency care
               Ensuring co-ordination in planning
               Ensuring the effectiveness of PRIME (rural GPs and practice nurses trained in trauma
                management, who respond in support of the ambulance service)


This ECCT considers implications of the “Roadside to Bedside” strategy for South Canterbury, Canterbury
and West Coast regions and also interfaces with the Nelson - Marlborough District Health Board, due to
occasional variations in emergency responses in some bordering areas. In consideration of this, the ECCT
initiated a survey in conjunction with the New Zealand College of Midwives and St John to all emergency
ambulance providers in these regions.

AIM
Emergency ambulance service providers were surveyed on current maternal and neonatal emergency
transport, particularly with regard to access and transfer to secondary services from the community and
primary units.

Maternity care providers were also surveyed about their experiences relating to maternity cases in an aligned
but separate survey.

The survey aimed to identify what is currently working well, any barriers to mothers and babies accessing
safe, timely and effective care, and how often issues arise. Possible solutions to issues of concern have been
reported and it is hoped that the results of this survey will lead to an improved service for women and babies
and for all maternity care providers in the region.

METHODOLOGY

An introductory letter and questionnaire were sent to Team Leaders or Station Managers within St John and
Marlborough Ambulance Service in late July 2005 with completed surveys due by 2 September 2005.
Reminders were emailed through the St John network via senior management to encourage a greater
response to the survey.

Out of a total of 305 surveys sent, 45 responses were returned, giving a total response rate of 14.75%.

Six surveys were returned uncompleted due to lack of relevant maternity situations experienced by staff at
this rural St John station. (No data was recorded from these responses)




                                                      3
RECOMMENDATIONS


The survey findings and subsequent contributing reports are summarised with the following
recommendations. Full contributing reports follow the main survey text.




      Education regarding the use of RAPID Response numbers to women using maternity services

      Standardisation of questions asked by SouthComm staff on receipt of incoming calls

      Clear understanding of protocols for making complaints or for giving praise regarding lead maternity
       carers

      Clarification of legal issues regarding which practitioner assumes overall legal responsibility of the
       patient

      Further education of ambulance staff regarding capabilities of lead maternity carers

      Improved interaction and communication between ambulance staff and lead maternity carers

      Involvement of midwifery educators into ambulance maternity-related training

      Improved accessibility to training programmes for ambulance staff

      Revision of ambulance charges in maternity cases to include these costs as part of overall maternity
       funding



It is suggested that a review of these recommendations is made after a period of 6 and 12 months
following publication of this report to assess progress and any resulting outcomes.




                                                       4
SURVEY RESULTS

Results are listed in tabular form and by graphs where a question has a multiple or variable response.

Where the survey asked for comments regarding a particular situation, these comments have been added at
the end of each group of responses. Comments made by respondents are reported verbatim.


SECTION A:      SERVICE SPECIFICATIONS


    1. You are responding for the following service:

                Response                                      Number          Percentage
                St John                                       40              89%
                PRIME response                                1               2%
                St John / Rescue Helicopter                   2               4%
                Marlborough Ambulance                         2               4%
                TOTAL:                                        45              100%


    2. How long have you worked in this capacity?

                Response                                      Number          Percentage
                < 5 years                                     11              24%
                5 – 10 years                                  8               18%
                > 10 years                                    24              53%
                Not answered                                  1               2%
                Not applicable                                1               2%
                TOTAL:                                        45              100%


    3. What District Health Board does your district cover?

                Response                                      Number          Percentage
                Canterbury Rural                              5               11%
                Canterbury Urban                              1               2%
                Canterbury Rural and Urban                    13              29%
                South Canterbury Rural                        1               2%
                South Canterbury Rural and Urban              6               13%
                West Coast Rural                              2               4%
                West Coast Urban                              1               2%
                West Coast Rural and Urban                    8               18%
                Nelson / Marlborough Rural and Urban          8               18%
                TOTAL:                                        45              100%




                                                      5
   4. What geographic area does your work cover?

              Response                                      Number         Percentage
              Main urban                                    4              9%
              Secondary urban                               4              9%
              Minor urban                                   3              7%
              Rural centre                                  4              9%
              Rural area                                    2              4%
              Rural and urban                               16             36%
              Secondary urban and rural                     3              7%
              Main urban and rural centre                   1              2%
              Main urban and rural area                     1              2%
              Rural centre and rural area                   2              4%
              Minor urban and rural area                    4              9%
              Main secondary and minor urban                1              2%
              TOTAL:                                        45             100%


The above regions are defined as follows:

      Main Urban Area                cities/towns with population over 30,000

      Secondary Urban Area           towns with population between 10,000 – 29,999

      Minor Urban                    towns with population between 1,000 – 9,999

      Rural Centre                   towns with population 300-999

      Rural Area                     all areas not specified as urban

      Both Rural and Urban           as above




                                                   6
SECTION B:             EMERGENCY SITUATIONS

   1. If you cover a rural area, are you always notified of the woman’s / baby’s “Rapid Response”
      number for locating the home address?

      Response                                                Number     Percentage
      Yes                                                     23         51%
      No                                                      5          11%
      Often number not given                                  3          7%
      Not all have a number                                   3          7%
      Use cross streets/roads/house description               2          4%
      Most times when available                               2          4%
      No - public do not know what Rapid Response number is
      and why it is used                                      1          2%
      No - correct number not always given                    1          2%
      Not answered                                            4          9%
      Not applicable                                          1          2%
      TOTAL:                                                  45         100%

   2. How many staff respond to a call?

      Response                                                Number          Percentage
      2                                                       37              82%
      3                                                       3               7%
      As many as required                                     1               2%
      Fire Service first aiders                               1               2%
      Two staff plus PRIME Doctor                             2               4%
      2 - 3 staff                                             1               2%
      TOTAL:                                                  45              100%


   3. What information are you given prior to responding to a call?

      Response                                                Number     Percentage
      Location , condition , other services responding        2          4%
      Address, chief complaint. Follow up advice on radio     3          7%
      Condition of patient                                    9          20%
      As given by SouthComm                                   14         31%
      Address and if maternity case                           4          9%
      Birth imminent, midwife present or not                  1          2%
      Priority level, incident, address and name              3          7%
      Is birth imminent or baby born already                  1          2%
      Priority, incident , address                            3          7%
      Minimal information                                     3          7%
      Code and address                                        1          2%
      Not answered                                            1          2%
      TOTAL:                                                  45         100%


                                                    7
4. Is there any other information you would like to receive?

   Response                                                           Number    Percentage
   The more information we receive, the better                        3         7%
   More than just basic information                                   1         2%
   Name of patient                                                    1         2%
   Specific type of emergency                                         1         2%
   Is Midwife and /or Doctor present?                                 2         4%
   Is closest hospital not receiving hospital?                        1         2%
   Is it maternity or childbirth specifically?                        1         2%
   What is status of baby?                                            1         2%
   Is this a first baby?                                              1         2%
   Whether PRIME doctor is attending with Midwife?                    1         2%
   What equipment is required?                                        1         2%
   Is it a transfer and why?                                          1         2%
   None extra                                                         4         9%
   Any maternity specialists at house, full labour details, inc
   contraction times                                                  1         2%
   Location, distance, cross streets (intersections)                  1         2%
   Not answered                                                       22        49%
   Not applicable                                                     2         4%
   TOTAL:                                                             45        100%

5. Do maternity care providers usually introduce themselves, indicating their role?

   Response                                         Number                     Percentage
   Yes                                              34                         76%
   No                                               9                          20%
   Not answered                                     2                          4%
   TOTAL:                                           45                         100%

6. Do you introduce yourself to maternity care providers, specifying your level of
   qualification?

   Response                                                       Number             Percentage
   Yes                                                            33                 73%
   No                                                             10                 22%
   Yes – without stating qualification                            1                  2%
   Not answered                                                   1                  2%
   TOTAL:                                                         45                 100%




                                                   8
7. Do you believe maternity care providers understand your level of skills/qualification?

   Response                                               Number         Percentage
   Yes                                                    3              7%
   No                                                     38             84%
   Don’t know                                             3              7%
   Not answered                                           1              2%
   TOTAL:                                                 45             100%




8. Do maternity care providers usually travel with you?

   Response                                               Number         Percentage
   Yes                                                    24             53%
   No                                                     13             29%
   Sometimes                                              3              7%
   As required                                            1              2%
   Not answered                                           4              9%
   TOTAL:                                                 45             100%




9. Are you able to take the family/whanau in the vehicle with you?

   Response                                               Number         Percentage
   Yes - 1 person                                         19             42%
   Yes - 2 people                                         12             27%
   Yes - 3 people                                         3              7%
   Yes - 4 people                                         1              2%
   Yes - 5 people                                         3              7%
   Yes - 6 people                                         1              2%
   Depends on patient condition                           2              4%
   No                                                     2              4%
   Sometimes – no number given                            1              2%
   Not answered                                           1              2%
   TOTAL:                                                 45             100%




                                              9
   10. Have you ever responded to an emergency to find that circumstances had changed and the
       ambulance was no longer necessary? What was your response to this situation?


        Response                                                            Number   Percentage
        Fine –part of job / adapt to situation/ happy for good outcome      14       31%
        Return to station                                                   4        9%

        No problem but are all volunteers who leave day job which
        can be difficult                                                    1        2%
        Make sure all was alright                                           1        2%
        Return to station - advise patient to follow up with General
        Practitioner /Midwife                                               1        2%
        Part of job. Ensure woman doesn’t hesitate to call again            21       47%
        No                                                                  1        2%
        Not answered                                                        1        2%
        Not applicable                                                      1        2%
        TOTAL:                                                              45       100%

COMMENT: The results of this question are encouraging and show an understanding on the part of
ambulance staff regarding the variable nature of maternity emergencies, where often a situation can
change dramatically in a short period of time.


11a1.   If you have had concerns about any aspect of service provided by a maternity care
        provider, did you notify anyone?

COMMENT: With regard to Questions 11a1 – 13b1, the correct procedure for expressing concerns and
compliments regarding the ambulance service, including how this process is implemented and
progressed, is outlined in the recommendations section.


        Response                                                       Number        Percentage
        Yes – manager (? ambulance – not specified)                    4             9%

        Yes – Supervisor / Team Leader St John                         2             4%

        Yes - person concerned                                         1             2%
        Yes – not specified                                            1             2%
        Not answered                                                   18            40%
        Not applicable                                                 19            42%
        TOTAL:                                                         45            100%

11a2.   If yes to Question 11a1, did you feel your concerns were acknowledged?

        Response                                                       Number        Percentage
        Yes                                                            6             14%
        No                                                             2             5%
        Not answered                                                   16            36%
        Not applicable                                                 20            45%
        TOTAL:                                                         45            100%




                                                      10
11a3.   If yes to Question 11a1, did you receive any feedback?

        Response                                                 Number   Percentage
        Yes                                                      4        9%
        No                                                       2        4%
        Not answered                                             19       42%
        Not applicable                                           20       44%
        TOTAL:                                                   45       100%

11b.    If no to Question 11a1, was it because you didn’t know who to address these concerns to?


        Response                                                 Number    Percentage
        No –didn’t know who to address                           13        29%
        Inappropriate to speak outside service                   1         2%
        No- “because nothing ever gets done”                     2         4%
        Not answered                                             16        36%
        Not applicable                                           13        29%
        TOTAL:                                                   45        100%

12.     Are you aware of whom to address any concerns about a maternity care provider to?

        Response                                                 Number    Percentage
        Hospital or Team manager                                 1         2%
        Maternity Unit manager                                   2         4%
        DHB                                                      3         7%
        Team Leader / Station Manager/ St John                   3         7%
        In service complaint via Ambulance District manager      2         4%
        Wairau Hospital Ward 1                                   1         2%
        No                                                       23        51%
        Team manager                                             1         2%
        Team manager and Maternity manager                       1         2%
        Maternity Manager and MW organisation                    1         2%
        DHB or private MW to MW board                            1         2%
        Yes - unspecified                                        1         2%
        MW / GP                                                  1         2%
        Not answered                                             4         9%
        TOTAL:                                                   45        100%




                                                    11
13.     Are you aware of whom to pass on compliments and recognition for good
        teamwork/skills/service?

        Response                                                    Number       Percentage
        Person concerned                                            3            7%
        Person concerned and their manager                          1            2%
        Station / Team Manager/ Ambulance                           2            4%
        District Health Board                                       1            2%
        Local medical centre                                        1            2%
        Wairau Hospital Ward 1                                      1            2%
        My crew                                                     1            2%
        Yes - not specified                                         5            11%
        Maternity Manager                                           1            2%
        District Health Board or for private Midwife to Midwifery
        Board                                                       2            4%
        District Manager                                            1            2%
        Not answered                                                7            16%
        Not applicable                                              19           42%
        TOTAL:                                                      45           100%




13a2.   If yes to Question 13, did you receive any feedback?

         Response                                                       Number    Percentage
         Yes                                                            4         9%
         No                                                             5         11%
         Not answered                                                   13        29%
         Not applicable                                                 23        51%
         TOTAL:                                                         45        100%



13b1.   If no to Question 13, was this because you did not know who to address these compliments
        to?


        Response                                                        Number    Percentage
        No – didn’t know who to                                         20        44%
        No - don’t think there is teamwork                              1         2%
        Not answered                                                    6         13%
        Not applicable                                                  18        40%
        TOTAL:                                                          45        100%




                                                       12
14.                           How would you rate your need for an updating of skills in dealing with the following
                              emergencies?

                                                                                                                                    Not              Not
Emergency                                            1 (low)           2           3 (med)           4              5 (high)        answered         applicable
Cord prolapse                                        1                 6           14                11             11              2
Shoulder dystocia                                    1                 3           12                12             15              2
Uterine inversion                                    1                 3           12                12             15              2
PPH management                                       2                 6           12                10             10              5
IV line insertion (adult)                            20                2           3                 2              10              5                3
Neonatal resuscitation                               6                 12          4                 7              12              3                1
Adult CPR                                            31                6           1                                4               2                1
Undiagnosed breech                                   2                 3           14                11             13              2
Other                                                                                                                               34               10




                                                                             Need for Skills Update

                         40



                         35



                         30
   Number of responses




                         25                                                                                                                               1 (low)
                                                                                                                                                          2
                                                                                                                                                          3 (med)
                         20                                                                                                                               4
                                                                                                                                                          5 (high)
                                                                                                                                                          Not answered
                         15                                                                                                                               Not applicable


                         10



                         5



                         0
                              Cord prolapse   Shoulder     Uterine       PPH             IV line     Neonatal      Adult CPR   Undiagnosed   Other
                                              dystocia    inversion   management       insertion   resuscitation                 breech
                                                                                        (adult)




                                                                                              13
15. Can you easily access skill updates/further training as required?

          Response                                                 Number     Percentage
          Yes                                                      16         36%
          No                                                       25         56%

          Yes - if doing National Ambulance Certificate            1          2%
          Not answered                                             3          7%
          TOTAL:                                                   45         100%


16. WHAT IS THE BEST THING ABOUT THE SERVICE / SYSTEM AT PRESENT?
      (Respondents were asked to express this in their own words - no suggestions were given)
Ambulance
         Fixed wing neonate /obstetric retrieval service to West Coast appears to work very well
         Opportunities to work in city for upskilling
         Haast has a few people who endeavour to help others; we would be in a bad situation otherwise
         Ambulance rarely required. 20 years ago many deliveries but system seems to be so much better
          now
         Midwife does not travel or respond to a call with us -it would delay response
      
                             nd
          Do training every 2 week. Can up skill if and when required
         Christchurch Women’s is based at Christchurch Hospital (which saves transporting patients from
          other hospitals)
         Dedication of volunteers as without them there would be no service

Maternity
         Easily contactable independent midwives
         Still based at local hospital, more convenient for patients
         Midwife is usually present on scene with patient. She is a specialist in this field.
         Good receiving hospital for urgent maternity care and premature baby resuscitation, covering a large
          rural area and some time from hospital

General
         Things work well at present
         Teamwork and satisfaction
         Making a difference and putting something back into the community

17.       WHAT WOULD YOU LIKE TO SEE IMPROVED OR CHANGED?

Ambulance
   More staff support
   Ambulance should be resuscitation experts – stand back and let us do our job
   Access to training times; more training; training night 1 or 2 x per year
   More across board training between ambulance and hospital
   Rural staff to have better access to city shifts
   Greater interaction between St John and West Coast DHB regarding services. There is a lack of
      current agreement/contract re Inter Hospital Transfers. Causes uncertainty and confusion re levels of
      service i.e.: vehicles, crew capabilities, response times etc and vehicles and crew being removed
      from emergency/ambulance cover to provide patient transfer services for DHB
   Evaluation of degree of urgency for ambulance response
   Communication updates
   Employ staff (interpreted as: rather than using volunteers)
   Would like to know what ward a patient needs to go to (at receiving hospital)
   Level of volunteer reimbursement

                                                       14
Maternity
    Fuller services at Ashburton Public Hospital
    Attitude of midwives
    We have no midwives in our area that we can call on
    Midwives to acknowledge skills of paramedic registered nurse when travelling in ambulance
    Earlier admission to hospital for first time mothers or mothers at risk
    Midwife or maternity team at Emergency Department on arrival
    More contact between midwife and PRIME responder

General
    Staff who communicate effectively



18.       WHAT IS THE WORST ASPECT OF THE CURRENT SYSTEM?

Ambulance

         Urgent transfers needed due to lack of services at Ashburton Public Hospital
         Poor management of service
         Current level of ambulance staff – volunteer training not fully inclusive and experience only gained on
          exposure to cases
         Often feel we are just a taxi service as working in an area very protected by existing staff
         Expectations made of the volunteers
         Lack of experience in rural areas due to low population. Need to work in city regularly
         Insufficient updates. St John is a large organisation and updates and up skilling take time to filter
          through
         Our distance from training areas as we still need to keep our skills up
         Having to go urgently to St George’s (Christchurch) and long waits. Because there is no loading bay
          at St Georges, they expect us to behave like Titan cranes and lift heavy women into ambulances
         Too many shifts/calls/on call duties - due to volunteer shortages
         Lack of staff and mismanagement of funding

Maternity

         Midwives don’t have identification. Is this person really qualified to be in charge of the delivery?
         Nil maternity support at hospital as staff consider ambulance at lower end of patient care scale
         Mix of independent and District Health Board midwives and conflict between staff
         Nearly every maternity transfer comes through as urgent. Ambulance staff are recalled then wait 30 -
          60 mins for midwife and/or doctor to be ready / organised for patient to depart hospital
         Midwives unwillingness to seek help early
         Don’t feel midwives are aware of ambulance staff abilities and they feel we are just taxi drivers
         No midwives in our area that we can call on

General

         PRIME covers each others areas on time off. Don’t know patients history and can be difficult tracking
          down when midwife is 3 hours drive away
         Staff lacking communication skills
         Adoption of home births in rural areas means unacceptable delays when things go wrong
         Not being informed of patients infectious level before having contact with patient
         Time spent waiting for retrieval team to put premature babies in incubator is too long – often 5 hours




                                                        15
ADDITIONAL GENERAL COMMENTS

Ambulance

      PRIME appear to want to run Rural Ambulance rather than be of support role

      Most times we are used in transportation with sick babies or parents to Christchurch or helicopter

      Little information from SouthComm on patient condition

      Information given by SouthComm is often incorrect or misleading

      SouthComm do a very good job providing information

      Strictly, we shouldn’t take any extra passengers due to loading certificates, especially in vehicles with
       Stolenwerk stretchers. We are not a bus

Maternity

      Due to patient privacy, if the midwife travels with us we are told very little. If no midwife with
       ambulance, getting info sometimes requires interrogation

      I am a qualified ambulance officer and have never had a maternity call. Would aim to assist midwife
       or doctor with thorough knowledge of ambulance familiarisation

      Maternity staff have generally not taken interest in ambulance developments and still ask for the
       ambulance “with oxygen in it” or “do you have a bag mask resuscitator in your ambulance” indicating
       to ambulance staff that we are considered to be ambulance “drivers”!

      Tell all midwives we do all carry oxygen, Entonox and all ambulances are physically the same

      Midwife wanted to run job, not at all interested in ambulance staff help

General

      In the Haast area, pregnant Mums are encouraged to leave the area before their due date, so are
       usually near to city services. We are therefore unlikely to strike many pregnancy situations

      A bad communicator bellowed orders at everyone and made a situation that didn’t need to be,
       unnecessarily stressful for all involved.

      Need public education re Rapid Response numbers as they do not know what this number is for




                                                       16
SECTION C:    SPECIFIC INCIDENTS



   1. Where was the emergency call made from?

      Response                                       Number        Percentage
      Home                                           25            66%
      Primary Care                                   11            29%
      Secondary Care                                 2             5%
      TOTAL:                                         38            100%

   2. What was the reason for the emergency response?

      Response                                       Number        Percentage
      Undiagnosed breech                             1             3%
      Foetal distress                                2             5%
      Cord prolapse                                  1             3%
      Pre term labour                                13            33%
      Neonatal resuscitation                         2             5%
      Retained placenta                              1             3%
      Prolonged labour                               7             18%
      PV Bleed                                       1             3%
      Home delivery – no midwife                     3             8%
      Unexpected sudden labour                       1             3%
      Birth imminent                                 2             5%
      Other – not stated or informed                 3             8%
      Labour (no other details given)                1             3%
      Cord around neck                               1             3%
      Birth imminent                                 1             3%
      TOTAL:                                         40            100%


   3. In your opinion, was the call from the maternity care provider for an ambulance made in a
      clinically appropriate time frame?

      Response                                       Number        Percentage
      Yes                                            22            59%
      No                                             7             19%
      Yes – call from woman                          2             5%
      Yes - call from family                         1             3%
      No maternity carer present                     1             3%
      No – call from woman                           1             3%
      Not answered                                   2             5%
      Not applicable                                 1             3%
      TOTAL:                                         37            100%


                                                17
4. In your opinion, was the appropriate type of emergency transport dispatched?

   Response                                       Number        Percentage
   Yes                                            34            89%
   No                                             1             3%
   Not answered                                   3             8%
   TOTAL:                                         38            100%




5. In your opinion, was the equipment provided by your vehicle appropriate for the situation?

   Response                                       Number        Percentage
   Yes                                            33            87%
   Not answered                                   4             11%
   Not applicable                                 1             3%
   TOTAL:                                         38            100%




6. Was specific equipment or a specific requirement requested at the time of the emergency
   call?

   Response                                       Number        Percentage
   Yes – not specified                            4             11%
   No                                             29            76%
   Not answered                                   4             11%
   Not applicable                                 1             3%
   TOTAL:                                         38            100%




7. Did the need for any extra equipment or service become evident after the call was made?

   Response                                       Number        Percentage
   Yes                                            6             16%
   No                                             28            74%
   Not answered                                   4             11%
   TOTAL:                                         38            100%




                                             18
8. Rate your interaction with the maternity care provider.

   Response                                        Number       Percentage
   Excellent                                       7            8%
   Very good                                       26           31%
   Satisfactory                                    28           34%
   Poor                                            6            7%
   Very poor                                       7            8%
   No midwife present                              1            1%
   Not answered                                    5            6%
   Not applicable                                  3            4%
   TOTAL:                                          83           100%


9. Rate the information you received from the Regional Communication Centre regarding the
   emergency situation?

   Response                                        Number       Percentage
   Excellent                                       7            9%
   Very good                                       34           41%
   Satisfactory                                    34           41%
   Very poor                                       2            2%
   Not answered                                    2            2%
   Not applicable                                  2            2%
   TOTAL:                                          1            1%
                                                   82           100%


10. Rate the communication between your service and specialist practitioners, other than the
    maternity care provider, for this situation.

   Response                                            Number   Percentage
   Excellent                                           5        6%
   Very good                                           25       31%
   Satisfactory                                        24       30%
   Poor                                                4        5%
   Very poor                                           3        4%
   Not answered                                        13       16%
   Not applicable                                      7        9%
   TOTAL:                                              81       100%




                                              19
SECTION C

SPECIFIC INCIDENTS

Respondents were asked to rate specific incidents using a Likert Scale with scoring ranging from Excellent to
Very Poor. The questions covered issues relating to the type of incident, appropriate timeliness of emergency
call, type of emergency vehicle dispatched, interaction with maternity care provider and communication with
SouthComm.

For analysis purposes, it was decided to only provide an in-depth report on incidents which gave a rating
across any category with a rating of poor or very poor, or respondents stated that an action / decision was
inappropriate in their opinion. These incidents are reported verbatim and do not always provide a full picture
of the circumstances involved. Information reported is based only on the information requested in the survey
and subsequently received from the respondent. Results have been clustered where possible as many
incidents were similar. The summarised results are as follows with the area of concern detailed in italics.

Incidents 1- 4
(these are 4 separate incidents with the same comments from one respondent)

       Call from primary care for prolonged labour
       Call for ambulance: made in appropriate time
       Equipment and transport: appropriate; no extra equipment requested or needed
       Interaction with maternity carer: Satisfactory
       Information from SouthComm: Satisfactory
       Communication with specialist practitioners other than maternity carer: Poor

Incident 5

       Call from secondary care for foetal distress
       Call for ambulance: made in appropriate time
       Transport dispatched: ambulance.
        Comment “should have used helicopter”
       Equipment provided: appropriate; no extra equipment requested or needed
       Information from SouthComm: Satisfactory
       Interaction with maternity carer: Very good
       Communication with specialist practitioners other than maternity carer: Satisfactory

Incident 6

       Call from home for shoulder dystocia and neonatal resuscitation
       Call for ambulance NOT made in appropriate time
       Equipment and transport provided was appropriate. No extra equipment requested at time of call.
        Midwife requested suction after initial call. Baby died.
        Comment: “Interaction with midwife was excellent however midwife was against (sic) and
        would not follow advice re emergency transport”
       Information from SouthComm: Excellent
       Communication with specialist practitioners other than maternity carer: Excellent


Incident 7 -11
(these are 4 separate incidents with the same comments from one respondent)

       Call from primary care facility for prolonged labour
       Call for ambulance made in appropriate time
       Equipment and transport provided was appropriate; no extra equipment requested or needed
       Interaction with maternity care provider: Very poor (no further explanation given)
       Information from SouthComm: Very good
       Communication with specialist practitioners other than maternity carer: Satisfactory


                                                      20
Incident 12 -14
(these are 3 separate incidents with the same comments from one respondent)

      Call from home for pre term labour
      Call for ambulance: NOT made in appropriate time
       A) call made by Patient B) call made by relative C) call made by Police
      Equipment and transport: appropriate; no extra equipment requested or needed
      Interaction with maternity carer: Satisfactory
      Information from SouthComm: Very good
      Communication with specialist practitioners other than maternity carer: Very good

Incident 15

      Call from Primary Care for foetal distress
      Call for ambulance by Maternity carer: NOT made in appropriate time
      Equipment and transport: appropriate; no extra equipment requested or needed
      Interaction with maternity carer: Satisfactory
      Information from SouthComm: Satisfactory
      Communication with specialist practitioners other than maternity carer: Not applicable

Incident 16

      Call from Primary Care for maternal suturing
      Call for ambulance by Maternity carer: made in appropriate time
      Equipment and transport: appropriate; no extra equipment requested or needed
      Interaction with maternity carer: Poor
       Comment “Midwife having a bad day. Taking it out on us”
      Information from SouthComm: Poor
       Comment: “Needed a crystal ball to determine problem/reason. RCC (SouthComm) couldn’t
       give us further information. They weren’t told”
      Communication with specialist practitioners other than maternity carer: Very good

Incident 17

      Call from Primary Care for pre term labour
      Call for ambulance by Maternity carer: made in appropriate time
      Transport dispatched: appropriate; no extra equipment requested a time of call.
      Stretcher later needed for helicopter
      Interaction with maternity carer: Very poor
      Comment: Head person from Christchurch via Air Ambulance demonstrated very poor directional
       request skills
      Information from SouthComm: Satisfactory
      Communication with specialist practitioners other than maternity carer: Very good. Good with local
       Doctor, Fire Service, provision of stretcher and other staff of Kaikoura Hospital.


Incident 18

      Call from home for retained placenta following “instant birth”
      Call for ambulance by Maternity carer: NOT made in appropriate time
       Comment:” Very concerned over length of time for concern from midwife over retained
       placenta i.e. I hour 20 minutes”
      Equipment and transport: appropriate; no extra equipment requested or needed
      Interaction with maternity carer: Satisfactory
      Information from SouthComm: Satisfactory
      Communication with specialist practitioners other than maternity carer: Satisfactory




                                                    21
Incident 19

      Call from home for normal labour
      Call for ambulance by Maternity carer: NOT made
       Comment: Midwife unavailable. Water broke at home on Friday. Patient at home alone with
       no support. Called ambulance on Sunday. Contractions 5 minutes apart.
      Equipment and transport: appropriate; no extra equipment requested or needed
       Comment: Hospital reception is poorly equipped for ambulance arrivals. No wheelchairs were
       available. Poor reception / directions. Whether it is the general public or ambulance, the reception at
       Christchurch Women’s is inadequately set up.
      Interaction with maternity carer: No interaction
      Information from SouthComm: Satisfactory
       Comment “No Rapid number given. No indication of estimated time of arrival of PRIME doctor”.
      Communication with specialist practitioners other than maternity carer: Satisfactory


Incident 20

      Call from home for retained placenta
      Call for ambulance by Maternity carer: made in appropriate time
      Transport: Inappropriate
       Comment: “Locum doctor asked to respond but refused”
      Equipment: appropriate; no extra equipment requested or needed
      Interaction with maternity carer: Poor.
       Comment: “Doctor refused to go. No other available early in incident”
      Information from SouthComm: Satisfactory
      Communication with specialist practitioners other than maternity carer: Poor

Incident 21

      Call from Primary care for prolonged labour
      Call for ambulance by Maternity Carer: NOT made in appropriate time
       Comment: “Call should have been made much earlier”
      Equipment and transport: appropriate; no extra equipment requested or needed
      Interaction with maternity carer: Satisfactory
      Information from SouthComm: Satisfactory
      Communication with specialist practitioners other than maternity carer: Very poor (no further
       comment given)

Incident 22

      Call from: Home; reason not stated
      Call for ambulance by Maternity Carer: NOT made in appropriate time
       Comment: “The woman was having an uncontrolled haemorrhage”
      Equipment and transport: Not answered
      Interaction with maternity carer: Very poor
       Comment: “The maternity care provider was very overwhelming but was more concerned
       about her reputation than care”
      Information from SouthComm: Satisfactory
      Communication with specialist practitioners other than maternity carer: Satisfactory




                                                     22
CONTRIBUTING RESPONSES

The survey findings and respondent’s comments have wide implications for those involved in emergency
ambulance and maternity care. St John Operations, St John Clinical Education Unit, SouthComm and the
College of Midwifes have all addressed issues raised as relevant to their organisation and have commented
below.

SOUTHCOMM RESPONSE

Responses to specific questions or comments:

      Evaluation of the degree of urgency for ambulance response

       This is now carried out using ProQA. ProQA is an internationally recognised system of call
       taking for ambulance emergency calls. It is based on a set of algorithms that allows Emergency
       Medical Dispatchers (EMDs) to illicit as much relevant information as possible regarding a
       patient’s condition. This information is then transmitted to the ambulance crews. ProQA will, as a
       result of questioning caller determine the degree of urgency and the skill level of response required.

      What ward the patient needs to go to (at receiving hospital)

       SouthComm (formerly Regional Communications Centre RCC) staff can access this information from
       receiving hospital and transmit this information to crews using Mobile Data Terminal (MDT)
       technology once installed in each ambulance as part of the Ambulance Communications Project.

      Little information (from SouthComm) on patient condition

       ProQA ensures that a consistent approach to call taking is maintained and consequently will
       provide much more detail on patient condition.

      Information given (by SouthComm) is often incorrect or misleading

       ProQA ensures that a consistent approach to call taking is maintained and consequently will
       provide more accurate information.

      Need public education re Rapid Response numbers as public do not know what this number
       is.

       This should be pursued through a joint emergency services forum with developing a public
       educational programme. This is not an issue for the RCC in isolation.

       RAPID NUMBER (Rural Address Property IDentifiers) are numbers which identify properties in rural
       locations. Property owners display their identifying numbers on a post or their letterbox or
       entranceway / fence. The posts are supplied by District Councils within territorial authorities. The
       numbers relate to specific roads, road intersections and distances from major intersections. The
       numbers can also be linked to map grid references. In an emergency situation, the Regional
       Communication Centres can use these numbers to rapidly and accurately locate the site of the
       emergency.

       It will be recommended that Lead Maternity Carers with rural women in their care, will record RAPID
       numbers on patient notes and explain their use to women and their families. In the case of a rural
       emergency situation, the midwife, woman and her family will be encouraged to use these numbers
       when requesting emergency assistance.

      Specific incident 16

       RCC staff will always relay all details received. Historically this has been subject to the questions
       being asked by the Calltaker. ProQA ensures that a consistent approach to call taking is maintained
       and therefore the same questions will be asked by all Calltakers.


                                                    23
ST JOHN OPERATIONS RESPONSE


Some comments were made that were not directly related to Maternity issues and will be handled in an
appropriate forum within St John.


       Training

St John and Midwifery trainers will work to develop and introduce a training module for both groups at initial
and refresher level. This module will clarify roles and responsibilities for all parties and include ambulance
resourcing and equipment overview. It is hoped that this will result in improved understanding between
ambulance staff and midwifes regarding roles and responsibilities.

St John ambulance staff first receive basic maternity training at National Certificate level. There is no
expectation on staff of a lower qualification level be proficient in areas where they have received no training.
Ambulance crews of lower qualification levels primary role is to provide support and transport role for LMC’s,
the mother and/or baby.

St John accepts that the LMC has clinical responsibility for their patient whereas St John accepts
responsibility for the safe passage of all passengers with provision of clinical support as required. However
the ideal is for both ambulance staff and LMC’s to work in a collaborative environment to achieve best
outcomes for mother and baby.


       Communication

Ambulance crews are responsible for providing radio updates, placing requests for additional or alternative
resources once the LMC, mother and/or baby are on the vehicle.


       General

If an LMC requires specialist retrieval team (urban and rural) assistance and / or equipment (i.e.: incubator)
they need to contact Christchurch Women’s Hospital to seek availability. Christchurch Women’s will then
request an ambulance response to collect the team and/or equipment and transport to the LMC

       Equipment/Resources

Equipment provided on all ambulances is nationally prescribed. St John is not licensed to carry additional
equipment or drugs for use by non-ambulance staff. For this reason it is important that LMC’s make
themselves familiar with the equipment that is standard on ambulances and they carry any additional items
and medication (including for example ecbolics) they require.

If a car seat is required, this request is to be made by the LMC at the time of lodging the emergency call with
SouthComm.




                                                      24
ST JOHN CLINICAL EDUCATION UNIT



PROPOSED TRAINING PROGRAMME

It is recommended that a training programme be developed for lead maternity carers. This session would be
open to student midwives as well as practicing midwives. Further discussion would need to be held with
midwifery tutors if this programme was to be included in the national midwifery degree.


   A suggested programme of approximately 2 – 3 hours should aim to include the following:

      An overview of the New Zealand Ambulance Structure and how the service is contracted and funded
       throughout the country. Regional variations betweens service providers should be outlined.

      An overview of the service structure and operational aspects of the ambulance service, particularly in
       the Canterbury / West Coast regions including the process for complaints and compliments

      Ambulance training and qualifications structure outlining the capabilities and limitations of each level
       of ambulance training

      Ambulance equipment including what constitutes a standard minimum including medication those
       ambulances are licensed to carry. Practical issues such as the safe carriage of newborn babies and
       difficulties in heating ambulances etc. should be discussed.

      Outline the process for review of equipment and medication carried on ambulances through the
       District Clinical Advisory Group through St John

      Emergency Air Ambulance / Helicopter overview

      Understanding of emergency communications process and the standardisation of all information
       requested by SouthComm from lead maternity carers and given to ambulance staff responding to call.
       This would also include an overview of the call and dispatch processes.



OTHER RECOMMENDATIONS

      Helicopter issues – contract issues, user safety, training course (Level 1 Safety Course) for those
       lead maternity carers likely to be working on or near helicopters, particularly rural lead maternity
       carers

      Determine the need for a joint review process of a selection of emergency cases through discussion
       between all relevant stakeholders. The suggested group members would be the clinical advisor to St
       John, an obstetric specialist, a midwifery representative (New Zealand College of Midwives) and an
       ambulance representative (e.g.: District Operations Manager).

      Consider the set up of a direct line into Christchurch Women’s (labour ward) where SouthComm can
       gain extra information as required




                                                     25
CANTERBURY / WEST COAST REGION NEW ZEALAND COLLEGE OF MIDWIVES
The New Zealand College of Midwives (NZCOM) is the professional organisation for Midwives in New
Zealand. The role of NZCOM includes setting the standards for the profession as described in the Midwives
Handbook for Practice (NZCOM). NZCOM also has contracts with the Ministry of Health to provide some
areas of ongoing education for midwives.

NZCOM provides feedback and consultation at many levels on midwifery and maternity services. The basis of
the NZCOM philosophy is partnership with women and the College encourages women to become consumer
members of NZCOM and to take part in its consultative processes.

EDUCATION OF AMBULANCE STAFF RE: MATERNITY CARE AND SERVICES

It is clear from the survey results that there is a lack of understanding on both sides as to the roles and
responsibilities of maternity service and ambulance staff providers.

The Canterbury/West Coast Region NZCOM sees that the requirements for education of ambulance staff
would include two separate areas:

1. Education for ambulance staff about the basic care needed at a birth or in other obstetric emergency
   situations.

2. Education for ambulance staff about the role and legal responsibilities of a Lead Maternity Carer under
   Section 88 of the NZ Health and Disability Act 2000

These are quite separate issues which are clearly both essential for ambulance staff to have adequate
education on. They could be included as a joint session or presented in separate sessions.

1.       Education for ambulance staff about the basic care needed at a birth or in other obstetric
         emergency situations.

Education in this area should be provided by a midwife with experience in education who is able to develop a
consistent programme in conjunction with St. John. It would be necessary to establish what is already
included in ambulance staff training programmes in order to work out a suitable programme and to clarify
what other aspects it would be necessary to cover.

Timeframes and frequency for this need to be established in conjunction with other training that ambulance
staff receive.

2.       Education for ambulance staff about the role and legal responsibilities of a Lead Maternity
         Carer under Section 88 of the NZ Health and Disability Act 2000

This session should be provided by local LMC’s and would ideally include representatives from different
practices in the region. Whilst it would be optimum to include rural midwives this may not be practical due to
time and cost restrictions. It may be useful to set up sessions in rural areas for the local teams with local
midwives.

An advantage of providing this session would be improved collegial relationships in terms of understanding
how each party works and particularly in rural areas it could be useful in building relationships amongst
providers who may be working together.

This session would include:

    Presentation of Section 88 of the NZ Health and Disability Act 2000 in terms of the midwives
     responsibilities to provide care. This would include the length of time midwives provide care for.

    Discussion of how midwives work on a day to day basis

    NZCOM Standards of Practice including the midwifery philosophy of partnership with the woman and her
     family, and support of woman’s choice.


                                                        26
   Options for women in New Zealand regarding choice of care provider and place of birth.

   Information about the appropriate choice of Primary Birthing Units or Home Birth for well women
    experiencing a normal pregnancy.

   Time for informal discussion

Estimated time for this session would be two hours.


PROCESSES FOR COMPLAINTS / COMPLIMENTS REGARDING MATERNITY CARE PROVIDERS

Lead maternity carers

Lead maternity carers (LMCs) are autonomous practitioners who most commonly work in within a group or a
practice. However, they are individually self-employed under Section 88 of the Health and Disabilities Act.

The first approach with a compliment or a complaint regarding care provided by a LMC should be directly to
the person concerned. The LMC may choose to inform their professional organisation, the New Zealand
College of Midwives (NZCOM), of any complaints or compliments they receive. The LMC may also request
support from NZCOM in any discussions or meetings that occur as a result of this process.

NZCOM is always readily available to provide support and guidance to midwives in this type of situation. The
initial approach would be to the Regional Chairperson for the NZCOM region involved. The Chairperson may
choose to seek further advice from NZCOM National Office if this was seen to be appropriate.

It would be inappropriate for the ambulance service to approach NZCOM directly - all concerns should be
addressed directly to the LMC concerned.

Employed maternity care providers

This includes Midwives employed as core facility staff, unit managers and as caseloading midwives.

As employed staff, any concerns or compliments about the care provided by an employee should be
addressed through the District Health Board (DHB) that employs them. All DHB’s have their own internal
policies and protocols with which to address these types of situations.

Employed staff could seek support from their employer, their union or their professional organisation in
addressing and responding to concerns.

RESPONSE TO SPECIFIC QUESTIONS OR COMMENTS

   Use of RAPID Response numbers

Midwives have not consistently used Rapid Response numbers as part of the information gathered at a
booking visit. However to obtain a Rapid Response number from the woman or her family, at the time of
calling an emergency transport service, may not always be easy or appropriate. Including a designated
space for the Rapid Response number on booking forms would encourage midwives to obtain this information
at the booking visit and it would be readily available in case of need. If women are unsure of this number, they
should contact their District Council.

Appropriate forms on which to include Rapid Response numbers include Hospital Booking forms and self-
employed midwives case notes. These are reviewed and reprinted at varying intervals. The majority of self-
employed midwives within this region use the Maternity Midwifery Provider Organisation (MMPO) in order to
facilitate their claims. The notes developed by the MMPO are updated and reprinted as required.

Discussion could be initiated with appropriate parties around inclusion of this information as forms/notes are
updated.


                                                      27
   Standardisation of information given to SouthComm by lead maternity carers and other maternity
    care providers.


Self employed midwives and midwives employed by DHBs, either in a caseloading capacity or as core staff,
may not be aware of what questions they will be asked by SouthComm. They also may not be aware of what
the questions mean in practical terms or what terminology indicates the level of emergency transport they
require.

Development of a system to inform maternity care providers of what information they are required to provide
would streamline this process and ensure that comprehensive, relevant information is provided. (Examples of
these initiatives as recommended by SouthComm have been included in this report and can easily be
implemented.)

Lead maternity carers and other providers may be making a call for emergency transport from the woman’s
home and may not have a private area to make this call, i.e. the woman and family may be able to hear the
conversation which is occurring. When processes and questions are being developed this needs to be taken
into account as the midwife will not want to alarm the family unnecessarily, and may not have time or the
opportunity to explain terminology used to the family.


   Clear understanding of protocols for giving praise regarding the ambulance service


Maternity care providers are very appreciative of the service provided by transport staff. Effective, appropriate
care will enhance what may be a stressful situation. Whilst the maternity care provider will have a
responsibility to continue care until arrival at a secondary or tertiary facility, a collaborative, team approach
with transport staff adds to the safety of the woman and/or her baby. Maternity care providers may thank staff
involved at the time of the transport, but are not always aware of how to pass on formal compliments, or
acknowledgments, for services provided. Communicating this to providers would allow for this to occur on a
more frequent basis. This process as recommended by St John Operations has been included in a report to
Midwives and can easily be implemented.


   Further education for maternity care providers regarding roles, qualifications and skills of
    ambulance staff; and regarding equipment availability on ambulances

Maternity care providers may not always be aware of roles, qualifications and skills of ambulance staff, or of
equipment carried in ambulances. This may particularly be the case in areas where there are a variety of
services, or where the area the provider works in, covers a range of services. Maternity care providers may
not be aware of differences between trained staff and volunteers.

Education to provide this information as part of a session for maternity care providers about ambulance
services would increase the clarity around requesting transport services and the giving of information both at
the time of the request and at the arrival of the transport. This would enhance communication and collegial
relationships by ensuring everyone was aware of what to expect and by ensuring the ambulance staff felt
confident that maternity care providers were aware of the service they were able to provide. Ultimately, a
team approach between both services offers the best outcome or woman and baby. Details of ambulance
staff skills are included in a report to midwives.

However, it is also important to note that the compulsory and elective education which midwives are required
to attend in order to maintain their Annual Practising Certificates, has increased significantly in the last two
years since the appointment of the Midwifery Council in 2004. This had had an impact on midwives in terms
of time and the cost of attending education. This may mean that uptake may not be as good of other
education sessions while midwives become more familiar with their education requirements from the
Midwifery Council.




                                                       28
       Clarification of legal issues regarding which practitioner assumes overall legal responsibility
        of the patient

Self-employed lead maternity carers (LMCs) sign a contract with the woman to provide care. This requires the
LMC to provide care for that woman according to Section 88 of the New Zealand Public Health and
Disabilities Act 2000. The contract may be signed at 14 weeks gestation or at any time after this, the woman
may also change her LMC at any stage and signs a contract with the LMC she has changed to. If the
woman’s care is no longer within normal limits, there are guidelines in Section 88 for referral to secondary or
tertiary care, depending on the condition. The referral guidelines are categorised as:
   Level 1:             The LMC may recommend that a consultation occur.

   Level 2:             The LMC must recommend that a consultation is warranted

   Level 3:             The LMC must recommend that responsibility for the woman or baby’s care
                         be transferred to a specialist.


In all situations the Section 88 document states that the decision must involve is a three-way negotiation
between the woman, the LMC and the specialist involved. In a situation where referral or transfer of care is
decided upon, the LMC is required under the contract to continue care of the woman or baby until care is
handed over to secondary / tertiary services.
The employed staff of a maternity facility will have a similar responsibility to provide care for a woman/baby
until the care is taken over by the secondary/tertiary facility which will be continuing that woman/baby’s care.

This information could be clearly and succinctly included in education for ambulance staff in order to clarify
the role and legal responsibilities of the LMC.


   Improved interaction and communication between ambulance staff and maternity care providers

Education around roles and responsibilities of maternity care providers for ambulance staff and of the roles,
qualifications and capabilities of ambulance staff and equipment available on ambulances, are detailed
elsewhere in this report. Clarification of these issues for all professional groups concerned would appear to be
an important step in improving interaction and communication between providers.
Many of the issues detailed in the survey seem to occur due to a lack of understanding or knowledge of the
role or responsibilities of the other service provider. This may be historical and due to past training or lack of
training. From the perspective of the ambulance staff knowledge of the care provided by maternity service
providers, and specifically LMCs, it may also be due to significant changes in the provision of maternity care
since 1990 in New Zealand.
It is also important that midwives communicate effectively with other emergency service responders (e.g.
PRIME, GP’s) and where appropriate, discuss issues about the woman and baby which may affect the care
provided by ambulance staff (e.g. Hepatitis B status).
It is anticipated that midwives would introduce themselves to ambulance staff and vice versa. It is not usually
necessary for midwives to wear identification as they have established a long term relationship with the
woman and her family. As self-employed midwives do not wear uniform, it is therefore the midwife’s
responsibility to introduce themselves to other health professionals who become involved in the woman’s
care.
   Transporting women in the LMC’s personal vehicle

It has been apparent from the survey that LMC’s under some circumstances do transport women in their own
vehicles. This can occur for a variety of reasons such as the woman has no transport available through to an
emergency situation where there may be delays in ambulance arrival.

The NZ College of Midwives does not recommend this practice, where other options exist. Issues of safety
for both the midwife and the woman can be compromised where private vehicles are used.


                                                       29
In emergency situations, midwives must have a clear rationale for choosing to transport women in their own
vehicle. They must consider all aspects of what is safest for the woman.

In situations where the woman has no transport, there is an anticipation that this will have been discussed by
the midwife during the pregnancy and alternate arrangements made prior to the birth.

   Funding of ambulance charges

Charges for ambulance use are not currently covered by Section 88 of the NZ Health and Disability Act 2000.
Midwives need to ensure that women and their families are aware they will be sent an account for $50 (2006)
as a contribution towards the cost of ambulance services.

   Retrieval team information

The decision to use a retrieval team is made by the Neonatal Unit or an obstetrician, after discussion with the
LMC. Retrieval teams are assembled on an as needs basis using available ward staff. This may require
additional staff being called in to cover the unit. The retrieval team is not on standby awaiting call outs. At
times, delays may be inevitable.

   Clinical decision making

The issues below were raised as comments by ambulance staff:

                Earlier admission to hospital for first time mothers
                Unacceptable delays in rural homebirths
                Midwives unwillingly to seek help early
                Timing of calls for ambulances

Midwives complete a three year degree programme to qualify and register as a practicing midwife. A midwife
is a specialist practitioner in normal birth and has been trained to identify when a situation is outside of normal
parameters and obstetric /paediatric assistance is required. Midwives are required to complete ongoing
education as required by the Midwifery Council on a three yearly cycle in order to maintain their annual
practicing certificate. For self employed midwives, this includes an annual review of their practice via the
NZCOM Midwifery Standards Review process.

LMC’s work independently and have responsibility to provide care for the woman and her baby, prior to,
during and after the birth. LMC’s are contractually bound to provide this care as described in Section 88 of the
NZ Health and Disability Act 2000. Further education for ambulance staff will lead to a better understanding
of how midwifery is practiced in New Zealand.

A maternity situation may change within a short time frame. Understandably, there will be situations where the
LMC may have called for an ambulance to find that the woman is not immediately ready for transfer or that a
transfer request was no longer needed; due to a change of circumstances (e.g. baby has been born).
Conversely, there will be situations where an ambulance has been called at an appropriate time but the
clinical situation has deteriorated in the intervening time from call to ambulance arrival. .

The LMC and the woman plan the birth during the pregnancy. It is usual to renegotiate the birth plan with the
woman and family if the situation is different to what has been planned. It is ultimately the woman and her
family’s decision as to what care they will choose, including decisions about when a transfer is necessary or
involvement of specialist care. This may not reflect what the LMC thinks is normal practice in these
circumstances. It may be difficult for the midwife to openly discuss these issues with the ambulance staff.

It may be appropriate for ambulance staff to discuss any issues regarding the situation with the LMC after
arrival at the hospital, once care has been handed over.

If ambulance staff are concerned about the care a woman and baby have received, and wish to make a
formal complaint, they are advised to follow the procedure outlined on page 27of this report.




                                                        30
SPECIFIC INCIDENTS (where previous comments have not already covered the issues raised)



Incidents 1 – 4

Comments re poor communication were relating to practitioners other than LMC’s.




Incident 5 and Incident 20

Concerns over what type of emergency response dispatched should be discussed with SouthComm who can
retrieve tapes of the emergency call and assess the decisions made.




Incidents 12 – 14

Emergency calls were made by a patient, a relative and police. No comment is possible from NZCOM in
these situations.




Incident 19

Issues re facilities at receiving or transferring hospitals need to be discussed through ambulance
management with the hospitals concerned.




                                                      31
ACKNOWLEDGEMENTS

The Canterbury West Coast Emergency Care Co-ordination Team would like to acknowledge the assistance
of the following individuals and groups in the production of this survey.

      St John Ambulance – Operations and Education
      SouthComm
      New Zealand College of Midwives – Canterbury / West Coast Region
      Women’s Health Division, Canterbury District Health Board
      Midland Emergency Care Co-ordination Team
      Tessa Watson - Data analysis




EXTRA COPIES

Extra copies of this report are available from the Canterbury West Coast Emergency Care Co-ordination
Team by contacting:

Marinda Hawthorne
Emergency Services Co-ordinator
P.O.Box 1443
CHRISTCHURCH

Or by email: marinda.hawthorne@stjohn.org.nz




                                                    32

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:7
posted:8/30/2012
language:Latin
pages:32