Abington - Jefferson Health Implements OB Trauma Alerts
ABINGTON, PA (September 13, 2018)—When we think about a pregnant woman’s interaction with the health care system, we think about frequent OB/GYN visits, ultrasounds and arriving at the hospital to deliver her baby. Most Americans don’t associate maternity patients with traumatic injuries. However, accidental injuries occur in six to seven percent of pregnant women in the United States. And though it’s not top-of-mind, trauma has become the most frequent cause of maternal death.
While deaths due to infection, hemorrhage, hypertension, and other causes have declined over the years, maternal deaths due to motor vehicle accidents, penetrating trauma, suicide and homicide has risen steadily. Penetrating trauma (when an object enters tissue like in the case a gunshot or stabbing) accounts for as many as 36 percent of maternal deaths nationwide. In the case of gunshot wounds to the pregnant abdomen, overall maternal mortality is low (3.9 percent). Fetal mortality, on the other hand, is high, ranging between 40 and 70 percent.
A pregnant woman entering a hospital Emergency Department as a trauma brings not only a vulnerable fetus dependent on her for its life, but also challenging, potential medical problems unique to the pregnant woman. Leading maternity provider Abington Hospital-Jefferson Health, with approximately 4,800 deliveries annually, offers the pregnant trauma patient an expanded team of experts upon her arrival to meet those distinct needs.
To expedite care, this year Abington Hospital implemented overhead OB Trauma Alerts to quickly notify not only the trauma team, but also obstetrics providers to assemble in the Emergency Trauma Center’s trauma bay and prepare for the incoming OB trauma patient. An on-call OB/GYN attending physician, an OB/GYN resident, and Labor and Delivery nurses all work closely with the trauma team to manage the needs of this unique population.
The hospital’s close proximity to major highways, congested local roadways and the active obstetrics practices linked to the hospital makes it a busy destination for ambulances bringing pregnant patients from automobile accident scenes.
There are many challenges when caring for the pregnant trauma patient since there are two patients who require evaluation and potential treatment. When providing treatment to the pregnant trauma patient, the age of the fetus must be considered. This can be difficult to determine if the mother is unconscious or has an altered mental status, and there is no family present to provide information. The mother and fetus must be evaluated individually and collectively to provide for the best outcome for both. Careful consideration must also be made whether the mother can have x-rays, CT scans or other imaging studies performed. Imaging of the abdomen is usually not recommended, but if a C-section is performed, the trauma surgeons will evaluate the abdomen at the time of the C-section to assess for any injury.
If the mother stops breathing, an emergency C-section must occur within four minutes to save the life of the baby. In cases where fetuses do not survive the trauma, Abington Hospital provides bereavement counseling from specially trained nurses to patients and their families.
“Implementing the OB Trauma Alerts has been an extremely important initiative,” said James V. Yushak, MD, Director, Trauma Program, Abington Hospital. “The pregnant trauma patient has unique needs that are best met by having two teams of experts present upon her arrival.”
One of two trauma centers in Montgomery County, Abington Hospital is celebrating 30 years as an accredited level II Trauma Center this year.
What is a Trauma Center?
According to the Pennsylvania Trauma Systems Foundation website, trauma centers provide specialized medical services and resources to patients suffering from traumatic injuries. Appropriate treatment has been shown to reduce the likelihood of death or permanent disability to injured patients.
Accredited trauma centers must be continuously prepared to treat the most serious life threatening and disabling injuries. The major component that differentiates a regular hospital from one that is a trauma center is the requirement for 24-hour availability of a team of specially trained healthcare providers who have expertise in the care of severely injured patients. These providers may include trauma surgeons, neurosurgeons, orthopedic surgeons, cardiac surgeons, radiologists and nurses. Specialty resources may also include 24-hour availability of a trauma resuscitation area in the emergency department, an operating room, laboratory testing, diagnostic testing, blood bank and pharmacy.
Hospitals that pursue trauma center accreditation must comply with the Standards of Accreditation of the Pennsylvania Trauma Systems Foundation. An aggressive trauma care accreditation process is required to assure trauma care is delivered according to established standards of care.