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Wednesday
Feb232011

Comment of the Week: Changing 9-1-1 Protocol Standards for Childbirth?

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This comment was written by Ben in response to the post, The Shoelace Protocol.

emjaybee asked “I wonder who wrote up the first ones, and how often they get reviewed/updated and by whom?” I happen to know the answer to this question. I used to work for the organization that creates these standards. I’m not a doctor—I’m actually a writer—but I worked closely with the doc who originally wrote the protocols. His name is Dr. Jeff Clawson, and he originally wrote the protocols back in 1978. Since then the National Academy of Emergency Medical Dispatch has been formed to review and update the protocols regularly. They have a council that meets every year or so to consider changes.

Note that the Academy isn’t a government organization. Like the American Heart Association, it’s a nonprofit organization that has become the national standard mainly through its widespread use and acceptance by doctors and dispatch centers. This protocol isn’t used everywhere in the US. It’s adopted voluntarily, and it’s up to each city, county, or state to make their own decisions and policies.

I think it would be wonderful to have midwives involved in the evolution of the 9-1-1 protocol standards. My wife became a doula a little over a year ago (she sent me the link to this post), and I wish I could have used her knowledge while I was still working for the Academy and Dr. Clawson. I would encourage you to visit their website and get in touch with them to see if there is anything you can do to help. In particular, Sarah, the 9-1-1 dispatcher who shared the protocol information in this post, is likely a member of the Academy and therefore has the ability to speak with her superiors and send in a formal Proposal for Change with supporting evidence to be reviewed at their next council meeting. The Academy’s website is located at http://www.emergencydispatch.org.

 

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Reader Comments (5)

You got it! I went to their website and emailed the four people who had email addresses:

To Mr. Freitag, Ms. Page, Mr. Massengale, Ms. Vanbeuge and others concerned,

I am writing to you with a proposal/request for change in the 911 protocol regarding directions for precipitous childbirth, specifically regarding the “shoelace protocol.” If I have written to the wrong location, please forward to the correct persons.

To the best of my knowledge, the current protocol reads (regarding tying off the umbilical cord):

“Listen carefully and I’ll tell you exactly what to do next. Without pulling on the cord, tie a string (shoelace) tightly around the umbilical cord, about 6 inches from the baby.”

I would like to propose the following:

(1) That a shoelace or string not be recommended for use.
(2) That cord clamping not be recommended at all.

Point #1: That a shoelace or string not be recommended for use.

I submit the following article for your examination:

http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2010/6/19/those-darned-shoelaces.html

The point being that used shoelaces are filthy and infested with bacteria and should have no place on a baby’s umbilical cord.

Point #2: That cord clamping not be recommended at all.

There is increasing evidence that clamping the cord while blood is still flowing from the placenta to the baby is both unnecessary and harmful to the baby. There has been a flood of articles in the news over the past six months on this issue, which I am sure you have seen, so I will just submit the following by obstetrician Nicholas Fogelson:

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

In summary, it is safer for the baby and much more hygienic if the cord is simply left to finish its delivery of blood to the newborn, rather than being unhygienically and prematurely clamped, which both keeps the baby from receiving his entire blood volume and introduces the possibility of dangerous pathogens onto the umbilical cord. In that case, the cord can simply be cut with sterile instruments by emergency services when they arrive, which is healthier in both ways for the newborn (and also gives less trouble to the parents).

Please feel free to contact me regarding either suggestion.

Sincerely Yours,
Diana J.

February 23, 2011 | Unregistered CommenterDiana J.

I did too!

February 23, 2011 | Unregistered CommenterNicole

Wow, I'm honored to have made Comment of the Week! :) I should mention that any requests for change to the Academy will have much more weight if they are sent in by members of the Academy. In fact, they generally don't seriously consider requests sent in through other routes. All 9-1-1 dispatchers certified to use the Academy's protocols are automatically members. If you can find an Academy member to send in the request for change via their official channels, the request will get much more attention. In addition, providing scientific studies that support your argument will give your request a better chance.

If your goal is simply to send information and/or start a conversation with the Academy, sending an email is not a bad thing. You might get a little closer to your goal by sending your email to the Council of Research Chair or the Council of Standards Chair. Their email addresses are both found on this page: http://www.emergencydispatch.org/BoardsCouncils. They are both more directly involved in the actual process of changing the protocol, while the folks on the contact page are more involved in general administration and such.

Good luck!

February 24, 2011 | Unregistered CommenterBen

Hello Ben! It's Sarah the dispatcher. Imagine how honored I felt when I got to be a guest poster! :) Anyhow, I didn't even know that I could submit changed to NEMD. Interesting! I will work on writing something up on my next night shift. Thanks for the good info.

February 25, 2011 | Unregistered CommenterSarah (Dispatcher)

Hi, Sarah! You will want to get a Proposal for Change form, which you can download from their website. Fill it out and send it in through official channels if possible (via your Dispatch Review Committee, supervisor or whatever). Let me know if I can help. :)

February 25, 2011 | Unregistered CommenterBen
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