Implementation Strategies to Improve the Availability and Prophylactic Use of Oxytocin by Emergency Medical Services (EMS) providers for Pre-Hospital Births

Postpartum hemorrhage (PPH) is a life-threatening condition accounting for 12% of all maternal deaths in the US. The World Health Organization and all American medical associations and colleges recommend that a uterotonic (e.g. oxytocin) be administered during the third stage of labor to prevent PPH, especially in low-resources setting with limited access to advanced care and medications. Utah EMS does not use oxytocin to prevent PPH and some agencies do not even carry oxytocin. Data from the Bureau of Emergency Medical Services and Preparedness show that oxytocin was used in less than 2% of all births attended by EMS. This project is the first step in implementing Active Management of the Third Stage of Labor (AMTSL) for pre-hospital births performed by EMS in Utah by identifying the barriers and facilitators to AMTLS.

This project has 4 objectives: 1) determine provider knowledge, attitudes, and practice around the use of oxytocin for AMTSL; 2) identify agency and medical director(s) willingness and hindrance to update the protocol; 3) conduct a landscape analysis on the scope of practice of providers and use of oxytocin across all levels; and 4) create a templated protocol for the prophylactic administration of oxytocin in Utah.

We will conduct a survey on the availability, education, safety and willingness to use oxytocin; conduct key stakeholder in-depth interviews; and conduct focus groups with stakeholders using participatory design principles to co-create a templated final AMTSL protocol. At the completion of the project, we will present the landscape analysis and templated protocol to the Utah EMS authority for consideration of adoption, and apply for NIH funds for an implementation science study that evaluates how various forms of training, including simulation, impact the adoption of AMTSL.

Current Status

2024-02-05
Postpartum hemorrhage (PPH) is a life-threatening condition accounting for 12% of all maternal deaths in the US. The World Health Organization and all American medical associations and colleges recommend that a uterotonic (e.g. oxytocin) be administered during the third stage of labor to prevent PPH, especially in low-resource settings with limited access to advanced care and medications. Utah EMS does not use oxytocin to prevent PPH and some agencies do not carry oxytocin. This is not uncommon in the US as we could find no prehospital EMS agencies that administered oxytocin to prevent PPH. The objective of this project was to update the Utah Emergency Medical Services Protocol Guidelines on prehospital births to match the guidance for the advanced management of the third stage of labor to prevent PPH. To achieve this goal, we hosted focus groups with providers and directors to understand the barriers and facilitators in their practice, agency, and region to updating the protocol. After this, we hosted structured interviews with select members of the Utah EMS Protocol Guidelines Workgroup to understand facilitators or barriers to updating this protocol from their perspective. Currently, we are creating a survey for hospital providers to understand if they have any barriers to this new protocol. At this time, we are on track to finish a written proposal to the Utah EMS Protocol Guidelines working group in March so it can be reviewed and added to a new edition of the protocols. With the remaining funds, we anticipate designing a training on this new protocol that can be disseminated with the update.