title: The obstetric caseload of a physician-based helicopter emergency medical service: case review and recommendations for retrieval physician training.
abstract: BACKGROUND
  The Greater Sydney Area Helicopter Emergency Medical Service provides physicians for undertaking prehospital and inter-hospital critical care. We quantified the obstetric caseload of our service with respect to primary diagnosis and interventions in order to provide targeted physician training.
  
  
  METHODS
  Retrieval records over a 4-year period were searched to identify keywords associated with pregnancy or obstetric complications. The data collected related to gestation, diagnosis, nature of transfer and interventions.
  
  
  CONCLUSIONS
  Of 66 pregnant or postpartum cases, 38 were transported by road and 28 by air. 33 had obstetric-related conditions, and 33 had non-obstetric medical conditions. 61 patients required mechanical ventilation, 23 of whom were intubated by the retrieval physicians prior to transport. 33 patients required vasoactive circulatory support, and arterial and/or central venous access was established in 48 and 30 patients, respectively. The only obstetric interventions provided by retrieval physicians were intravenous tocolytic therapy (two cases) and one case of resuscitative hysterotomy (peri-mortem caesarean section).
  
  
  CONCLUSIONS
  A half of all peri-partum patients in our critical care transport service are retrieved for non-obstetric diagnoses. Obstetric interventions by retrieval physicians are rare, but resuscitative hysterotomy may be required. Most interventions are general critical care procedures. Exhaustive training in obstetric emergencies may not reflect the learning needs of retrieval physicians in services such as ours. Educational resources should prioritise general critical care of the pregnant woman rather than specific obstetric procedures. We have used these findings to construct a targeted obstetric module as part of our retrieval physician training programme.
authors.affiliation: Department of Anaesthesia, South West Peninsula Deanery, Plymouth, Devon, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Kaye
authors.affiliation: Department of Anaesthesia, Wessex Deanery, Southampton, Hampshire, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shewry
authors.affiliation: New South Wales Ambulance Service, Greater Sydney Area HEMS, Bankstown, New South Wales, Australia.
authors.forename: Cliff
authors.initials: C
authors.lastname: Reid
authors.affiliation: New South Wales Ambulance Service, Greater Sydney Area HEMS, Bankstown, New South Wales, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D004501:Education, Medical; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009517:New South Wales; D007744:Obstetric Labor Complications; D010819:Physician's Role; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data; D055815:Young Adult
keywords: critical care transport; education; obstetrics and gynaecology; prehospital care; prehospital care, critical care transport