Israeli Paramedics Association
800 GM Preemie
by
Paramedic Neomi Zvi
One of the hotest afternoon of the Israeli summer.
Hadas & Gabbi (the volunteers) were helping me checking the MICU
Gilber , the EMT-I / MICU driver was checking the vehicle.
The Miller Blade No 0 was not working and I did not have a spare bulb ,
So I sent Gabbi to bring the 0 blade�s bulb from the reserve MICU.
Co-Incidence ?
On the way to the scene:
A minute later, we were dispatched to the next city (23 km away)
To a �Premature labor� .
�A BLS ambulace is on its way to the address�. Said the dispatcher.
4-5 minutes later , we heard Ron , the EMT-B (of the other city) reporting
about a 15 years old (!) that delivered alive preemie at home. He asked for
the MICU (us) and for the �Blues� (police)�..?!?
After a minute or so , Ron called me on the radio. He sounds in stress:
�He is really really small� said Ron �Should I block the umbilical cord � ?
�Yes� I answered � Block it with two clamps and cut inbetween� I continued
and put the radio mic on my knees�.
�That is weird� I said to Gilber
�What?� asked Gilber (the EMT-I , MICU driver)
�Ron is a very experienced EMT-B , he delivered a lot of babies ,
and he sounds stressed, and asked me what to do ?
something is wrong���..I answered.
�And he asked for the police as well. It is weird � continued Gilber
Gilber determine a joining point with the BLS ambulance at the city gate.
and parked the MICU on a side road near the main junction.
30 seconds later , Ron parked his BLS ambulance next to us.
Joining point
Ron and Gilber switched stretchers and loaded the two pt into the MICU ,
While Ron reported: �When I came to their home , the baby�s head was out
With the umbilical cord loop around his neck. At first they did not wanted me to
take care of the newborn , just to take the mother to the hospital. I called the
police , and in the mean time , I warned them that they�ll be charged of murder
if they�ll do something to the baby. I clamped the cord as you said� �.he was still
sounds a bit nervous and continued:
"I was alone with a preemie in distress , a non colaborating young mother , a
hostile grandfather ...and - Histeric young volunteer - instead of help !"
She was really young , the new mother, less then 15 y/o�the same as
my daughter�..next to her , wrapped with a towel was a tiny newborn.
The new grandfather was there too
The joy of a birth of a new baby was missing. But so the worries accompany
a premature labor and life threatening situation of the newborn was missing.
�What�s your name ?� I asked the mother
��Natasha� she said �I don�t want the baby� she whispered
�You won�t have too. What week of pregnancy you were? �
�27 weeks���
�Sweety , Gilber will take care of you now and I�ll be with you in a minute�
I gave orders while taking the baby .
�Gilber � Vital signs + IV line to the young mother. 2 min at the most and
you are driving �. �
�Hadas (Volunteer) - open the baby�s resuscitation beg , and the laryngoscopy set�
�Gabbi � prepare the aluminume blanket and the labor set�
�Ron � Thank you , put the heat on , the grandfather to sit in the front and have a
safe driving back to your station�
I stood on the MICU�s side stairs and put the wrapped newborn on the MICU�s bench,
when I noticed a spot of blood
on the towel. I opend the towel. There was no clamp on the left 4� of the umbilical
cord. I orderd Gabbi to clamp it (although it was not bleeding) and asked Gilber to
check if the placenta is out and if the cord is clamped.
�The placenta is not out yet , and yes , the cord have two clamps on it� said Gilber.
The preemie was about 800 gm, cold to touch , APGAR = 4- 5.
A = all blue = 0 point
P = about 95/min = 1 point
G = 1 point
A = 1-2 points
R = about 16-18/min , not effective = 1 point
The MICU was steaming from heat , and so were we�.. not so good
for the mother but critical for her baby in this point
The ventilation with the BVM was not effective either due to high resistance of the
Lungs (HMD , or just not enough Surfactan ?) .
� 2.5 mm ETT please���
Sniffing position
I gently put the 0 Miller Blade tip under the epiglotis and intubated.
Baby's BV + O2 connected to the reservoir pipe
Auscultation: well , and I had to ask for silence to hear that the tube was a little
deep I pulled it back about 3mm , till length of 7.5 cm
Ventilation of 8-10cc each time (it is easier to ventilate with a syringe...:-)
Natasha was watching every step of ours but barely answered my questions
Gilber reported: �The mother have HR of 95 / min , BP of 100/70 mmHg ,placenta
not out yet , and have already an IV line with Ringer and 2.5 min were spend..�
On the way to the hospital:
Gilber reported on the radio what I told him:
"15 y/o ,end of labor stage II , stable. 800 gm preemie ,Intubated & ventilated,
asking to open the east gate of the hospital - if not possible -
I wand the Preemie's ICU doc will wait for us with an incubator in the ER".
I asked for adhesive tape.
�This is so scary�.� said Hadas. She was shaking and Gabbi did not do better...
They did not succeed to follow my orders to prepare the ETT fixation , so I asked
Hadas to hold the ETT and ventilate.....But , she could'nt handle this
either due to stress. (Hadas is doing it perfectly almost every day with adult !)
The kind of tape we had was too nerrow (frequently we are run out of tape and
stuff and gets some improvised equipment)....
So I changed strategy. I fixed manualy the ETT , my finger in the baby's mouth
(he was sucking it constantly ...) , and covered his whole head with my palm
(direct heating).
I told Gabby to put his palm over the baby , under the blanket of course
Attaching the monitor's infant stickers was not easy job too.
"Where" ? " Where can I put the stickers "? he is so tinyyyyyyyy" said hadas.
"One on the back , one on the belly and one on the leg" I said......
Well , she did it but keep saying:" his leg diameter is like my finger...."
"Turn the heater off" I called Gilber .
"The sun is striking on the MICU 's windows and heat the bench , where the
baby is.." . And so , we managed a nature heater + our hands....
Sinus Rhythm of 137/min on the monitor , SaPO2 of 100% , wrapped in sterile
sheet , warmed , ventilated , PR temprature 37.8 c (100 F) the baby laid "in the sun"
and still sucking my finger....
We arrived the hospital after 22 minutes
A trip in the Hospital:
Gilber said: "They did not open the east gate and the guardian have no key"
"Hope the doc with the incubator is waiting us in the ER.
No body was waiting for us their.
I was really angry.
So we had to cross half of the hospital passages, by foot (most of the hospital
have ground floor only) and preventable exposer to the preemie
Gilber and Gabbi drived the stretcher with the mother , I was holding the baby
and the ETT , LP 10 hanged on my shoulder , and Hadas walking aside me ,
ventilating , and carry the Oxygen Cillinder .
We arrived the Gynecology. Gilber continued down the hall to the delivery room,
and I turned to the left into the Preemie's ICU.
In the Preemie's ICU:
They were expecting us but had no medical details. I put the baby in the open
incubator , continue ventilating.
"Who did the Intubation"? asked the in charge nurse.
"I did" I said......"Are you a doc?" ..she kept asking
"Nope. Just a Paramedic"..........."My hat down for you....."she said.
I reported after the doc checked for the ETT location
Born about 45 minutes ago , 27 weeks , to an unmarried 15 y/o mother,
one loop of Umbilical cord around the neck according the EMT-B ,
Brought to us with unblocked umbilical cord , cold , APGAR 4-5, good
sucking reflex. 2.5 ETT , larynx was relativly dry ,and the rest you know."
"One more thing - I know nothing about the pregnancy , nor the labor -
the kid refuse to tell and she does'nt want the baby - So I don't know what
was the story"
"Don't worry , people are waiting for babies........" said the doc.
After fixing the ETT , they put him on the scales. He wieghted 1050 gm
with the equipment - meaning his actual wieght is about 850-900 gm.
Outcome:
The next day . we have been in the hospital with another pt. and we went
to see the baby.
The baby was "the talk of the day". One of the nurses stepped toward me
and called: "Neomi , how are you ? I have'nt met you since the PALS
course you teached me......"
I asked the ICU doc about the preemie medical condition:
"He was little under the border line of Surfectant level , got 1 dose
only - and react very well , if everything goes well - we will extubate
in two or three days"
On the weekend local newspaper was written about Natasha.
The police suspect she was raped ...
Paramedic Neomi Zvi - Jan 2000