Epidemiology of prehospital obstetric conditions and out-of-hospital deliveries in the US

项目总结 在美国，每年有数以千计的意外分娩发生在家里，其中大多数引发了911紧急医疗事件 服务(EMS)激活(即呼叫服务)。对于这些高危患者，来自其他国家的证据 提示非计划外分娩(OHD)与产后风险增加有关 出血、新生儿体温过低、新生儿重症监护病房入院以及孕产妇和新生儿死亡。 然而，人们对OHD和其他产科疾病的流行病学和患者安全性知之甚少。 由美国的EMS人员提供。这些重大的知识差距导致缺乏任何基于证据的 产科EMS护理指南，以及该专业持续缺乏院前专门培训 妇幼保健领域。该探索性R21项目的总体目标是更好地 了解急救人员院前产科疾病的特点及临床护理 告知未来的干预措施，将减少发病率和死亡率，并改善院前患者护理。我们会 使用EMS患者护理记录的国家存储库，国家紧急医疗服务信息 系统(Nemsis)，调查母亲及其新生儿的院前护理。总而言之，来自 2018年1月至2019年12月，Nemsis包括来自47个州和 这是目前可用的最大的院前护理记录样本。 在目标1中，我们将描述OHD和OHD的患者、社区、应急反应和临床特征 EMS人员治疗的其他高危产科疾病，包括按关键因素检查差异 比如城市化、社区层面的种族分布和产妇年龄。在目标2中，我们将检查频率 和院前因素与OHD期间患者安全事件以及孕产妇和新生儿的安全事件相关 复苏。在目标3中，我们将使用改进的Delphi方法，由10-18名临床和EMS专家组成的小组来 确定研究重点，以改善产科疾病的院前护理。根据我们的试点数据，我们 估计为OHD确定约7,000个EMS激活，其中80%以上的电力用于统计 目标1和目标2中的分析。目前的R21项目将为第一个国家 描述美国产科患者的EMS护理和指导院前特定研究重点 旨在改善院前患者结局和安全性的研究和干预。这项研究直接回应了 NICHD优先改善对妊娠相关疾病和死亡率高危妇女的治疗； 儿童急救医疗服务研究特别关注的通知(非HD-19-022)； 紧急情况下特别关注研究的通知(NOT-NS-20-005)；和健康人2030 目的减少孕产妇死亡和严重的孕产妇并发症。

PROJECT SUMMARY Thousands of unplanned births occur at home in the US each year, and most trigger 911 emergency medical services (EMS) activations (i.e., calls for service). For these high-risk patients, evidence from other countries suggest unplanned out-of-hospital delivery (OHD) is associated with an increased risk of postpartum hemorrhage, neonatal hypothermia, neonatal intensive care unit admission, and maternal and neonatal death. However, little is known about the epidemiology and patient safety of OHD and other obstetric conditions treated by EMS personnel in the US. These major knowledge gaps have resulted in the lack of any evidence-based guidelines for EMS care of an obstetric patient and an ongoing lack of prehospital-specific training in this major area of maternal and child health. The overarching objective of this exploratory R21 project is to better understand the characteristics and clinical care of prehospital obstetric conditions treated by EMS personnel to inform future interventions that will reduce morbidity and mortality and improve prehospital patient care. We will use a national repository of EMS patient care records, the National Emergency Medical Services Information System (NEMSIS), to investigate prehospital care of mothers and their newborn infants. Collectively, from January 2018 to December 2019, NEMSIS includes >50 million EMS patient care records from 47 states and territories and over 10,000 EMS agencies, representing the largest sample of prehospital care records available. In Aim 1, we will describe the patient, community, emergency response, and clinical characteristics of OHDs and other high-risk obstetric conditions treated by EMS personnel, including examining differences by key factors like urbanicity, community-level racial distribution, and maternal age. In Aim 2, we will examine the frequency and prehospital factors associated with patient safety events during OHD and maternal and neonatal resuscitation. In Aim 3, we will use a modified Delphi method with a panel of 10-18 clinical and EMS experts to identify research priorities to improve prehospital care of obstetric conditions. Based on our pilot data, we estimate identifying approximately 7,000 EMS activations for OHD, with over 80% power for the statistical analyses in Aims 1 and 2. The present R21 project will provide a unique opportunity for the first national description of EMS care of obstetric patients in the US and prehospital-specific research priorities to guide research and interventions to improve prehospital patient outcomes and safety. This study directly responds to the NICHD priority to improve treatment of women at high risk for pregnancy-related morbidities and mortality; the Notice of Special Interest in Research on Emergency Medical Services for Children (NOT-HD-19-022); the Notice of Special Interest in Research in the Emergency Setting (NOT-NS-20-005); and the Healthy People 2030 objectives to reduce maternal deaths and severe maternal complications.