Emergency transport of obstetric patients within the Ugu Health District

Abstract

Background Information regarding pre-hospital emergency medical services is limited and it is therefore challenging to determine if there is delay in emergency transport of patients. This study aimed to provide such information specifically regarding the emergency transportation of obstetric patients. Purpose The purpose of the study was to describe the transport of obstetric patients within the Ugu Health District of KwaZulu Natal, in terms of patient profiles, the response time intervals and factors that affected response times. Objectives The objectives of the study were to:  determine response time intervals from the initial call to delivery of the patient to a public sector hospital;  describe the types of obstetric cases being transported;  describe factors that affect response times and;  make recommendations on policies and procedures governing emergency obstetric patient transportation Methodology All obstetric patients transported by Emergency Medical Rescue Service (EMRS) within a 2 month time frame within the Ugu District made up the study population. The study was conducted through prospective quantitative data collection using hospital records, the EMRS information system (communications centre data base records) and the EMRS patient return forms. The data was triangulated which established reliability before descriptive analysis was conducted. vi Findings The EMRS predominantly transports obstetric patients in labour with a gravidity of 1. The mean response interval (from receipt of the call to arrival at the patient) of 1h41minutes was a result of delays in the pre-response interval (pre-response waiting time). The mean pre-response interval of 1h07 minutes was a result of delays caused by ambulance unavailability. Pearson‟s correlation showed a significant relationship between the pre-response interval and response interval i.e. delays in the pre-response interval caused delays in the response interval. The EMRS lacks Standard operating procedures governing emergency transport and this was one of the main factors that contributed to some of the causes of ambulance unavailability. The lack of standard operating procedures is therefore also partly responsible for a delayed response interval. 64.5% of the incidents achieved response time intervals of more than 1hour and has therefore failed to achieve the predetermined Department of Health target for 70% of ambulances reaching the site of the patient within 1 hour. Other factors that affect the response time intervals were the poor road conditions, shift change delays and re-routing of ambulances. Conclusion EMRS predominantly transports obstetric patients in labour, including high risk patient groups that are arguably beyond the scope of care of the Basic and Intermediate qualified Emergency Care Practitioners. Standard operating procedures for governing emergency transport are lacking and have contributed to a number of factors affecting response time intervals. Standard operating procedures therefore need to be developed taking into consideration the findings of this study as well as previous recommendations by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD).