Standing Orders
1. Obtain pertinent history and perform physical exam.
2. If no imminent delivery, transport patient in position of comfort, usually on left side.
3. If question of imminent delivery, observe briefly, then transport unless delivery in progress. Be prepared to stop ambulance if delivery occurs en route.
4. If delivery in progress:
a. Assist delivery using clean or sterile technique.
b. Suction infant and protect from heat loss. See Pediatric Protocols - Newborn Emergencies page 2-6.
c. Double clamp and cut cord 8-10 in. from infant.
d. Give infant to mother and allow to nurse.
e. Transport; do not wait for or attempt delivery of placenta.
f. Closely observe infant for distress and mother for excessive postpartum bleeding.
g. Contact a medical control physician
Standing Orders
1. Begin oxygen therapy for any complications.
2. Immediate transport for:
a. prepartum or postpartum hemorrhage(moderate-heavy),
b. limb presentation,
c. prolapsed umbilical cord,
d. known multiple fetuses,
e. previous cesarean section.
3. Start IV Normal Saline en route.
4. If hypotensive, position patient on left side.
5. For postpartum hemorrhage
a. Oxygen therapy.
b. Massage uterus gently.
c. Consult med control physician regarding use of pneumatic compression trousers (PCT).
6. For prolapsed umbilical cord:
a. Oxygen therapy.
b. Place mother in knee-chest position or Trendelenburg.
c. Insert gloved finger into vagina and hold presenting part off cord.
d. Do not touch or attempt to replace cord.
7. For infant distress, see Pediatric Protocols - Newborn Emergencies page 2-6.
8. Contact a medical control physician for further orders for any complication.