Helen Ding
Helen Ding is an intern at Cosmos. She is a biomedical science graduate completing a master's degree in journalism at the University of Melbourne.
Rural ambulance volunteers are worried that they don’t have enough training to deal with birth emergencies: if a baby gets stuck and doesn’t progress, “calling for help is essentially our level of training,” says a rural volunteer ambulance officer who participated in a recent study from Edith Cowen University in Perth, Western Australia.
The research, led by PhD Candidate Michella Hill, sheds light on the significant challenges rural volunteer ambulance officers (VAOs) face when responding to unplanned out-of-hospital births (OOHBs) in rural and remote Australia.
VAOs are vital to Australia’s healthcare system. “They are unsung heroes in rural and remote areas … with some communities relying solely on VAOs in medical emergencies,” says Hill.
Unplanned OOHBs, while accounting for less than 1% of ambulance requests, have a high risk of life-threatening complications. According to the study, approximately 12% of OOHBs result in some form of complication, with this figure rising to an alarming 27% when all intrapartum cases are considered. These statistics highlight the critical role that trained healthcare professionals play during childbirth.
The study identified four areas of concern and called for more clinical support to be available to VAOs.
The first area of concern was lack of education and exposure to birth. Many VAO participants reported feeling underprepared to manage potential labour complications due to deficits in obstetric knowledge and/or lack of exposure to birthing. Most participants lacked confidence, admitting that they would feel anxious attending OOHBs. The level of anxiety was often dependent on their birthing experience and training.
Many were worried about limitations to scope of practice (imposed by clinical practice guidelines) and medical equipment availability.
All participants described the VAO scope of practice as being restricted to an “accoucheur” or birth assistant, with their guidelines advising them to “request assistance from a senior support officer and/or provide rapid transportation to definitive care [hospital].”
However, the availability of senior support officers in regional areas is cause for concern; and those with additional clinical qualifications reported not being able to use their skills when volunteering due to scope of practice restrictions.
Most participants also reported that only “a very limited obstetrics kit” was available to VAOs, which increased their anxiety. There are also logistical and communication difficulties.
Lack of maternity services in some rural hospitals, long travel distances to hospital care and the potential unavailability of aeromedical retrieval tended to complicate cases. Rural telecommunication problems resulting in difficulties accessing adequate support when required posed further challenges.
Some participants also felt the general public may be unaware that ambulance crews in rural areas may be primarily staffed by volunteers and expected that VOAs have the same level of competency as registered paramedics.
The study concludes that “adequate clinical, educational and organisational support should be available to VAOs to ensure continuation of essential emergency services to Australian communities.”
With funding from the Western Australia Department of Health and Women and Infants Research Foundation, Hill has been developing a simulation training program called NEONATE in VR – Novel Educational Overview of the Neonatal Agpar and Treatment Experience in Virtual Reality – for rural and remote clinicians who may not have access to in-person training.
“With virtual reality, you don’t need to organise for an expert trainer, because the virtual reality program is your expert trainer,” says Hill.
Hill says NEONATE in VR is more dynamic and interactive than other medical education programs and applications. It can create the “muscle memory” that is particularly important in paramedicine.
Hill believes the program could save hospitals time and money. “We are giving it for free to any organisation that wants to utilise it,” says Hill.
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