Unit 4: Patient Treatment and Transport
Obstetric, Pediatric, & Special Patient Care
Caring for pregnant patients, newborns, children, and older adults requires EMTs to recognize important differences in anatomy, physiology, and emergency treatment. This NREMT study guide covers childbirth, pregnancy complications, pediatric assessment, and special patient considerations. Understanding these differences helps EMTs provide safe and effective emergency care. Test your knowledge with five NREMT practice questions and detailed answer explanations.
Although the basic principles of emergency care remain the same, certain patients require modifications to assessment and treatment. EMTs must recognize these differences while continuing to prioritize airway, breathing, circulation, and immediate life threats.
Pregnancy and Obstetric Emergencies
Pregnancy causes significant changes in the cardiovascular and respiratory systems. EMTs should recognize several potentially life-threatening complications.
Ectopic Pregnancy
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube.
If the pregnancy ruptures, severe internal bleeding can occur. Signs may include abdominal pain, vaginal bleeding, dizziness, and shock.
Preeclampsia and Eclampsia
Preeclampsia is a pregnancy-related condition involving high blood pressure and signs of organ dysfunction, generally occurring after 20 weeks of pregnancy. It can also develop after delivery.
Warning signs include severe headache, vision changes, upper abdominal pain, and high blood pressure.
Eclampsia occurs when a patient develops seizures associated with preeclampsia.
Vaginal Bleeding
Significant vaginal bleeding during pregnancy may indicate miscarriage, placental abruption, placenta previa, or another serious complication.
EMTs should assess for shock, provide appropriate supportive care, and arrange prompt transport. Never perform an internal vaginal examination.
Assessing a Patient in Labor
When responding to a patient in labor, determine whether there is enough time for transport or whether delivery is imminent.
Important questions include:
- How many weeks pregnant are you?
- Is this your first delivery?
- How far apart are your contractions?
- Has your water broken?
- Do you feel the urge to push?
Crowning, when the baby’s head becomes visible at the vaginal opening, is an important sign of imminent delivery.
Labor is commonly divided into three stages:
| Stage | Description |
| First | Contractions begin and the cervix dilates completely. |
| Second | The newborn is delivered. |
| Third | The placenta is delivered. |
When delivery is imminent, prepare a clean area, use appropriate PPE, and have an obstetric (OB) kit ready.
Assisting With Childbirth
During a normal delivery, EMTs should:
- Position the patient comfortably and prepare for delivery.
- Gently support the newborn’s head as it emerges without pulling.
- Check for an umbilical cord around the neck.
- Support the newborn’s body as delivery continues.
- Immediately assess the newborn’s breathing, muscle tone, and heart rate.
A loosely wrapped umbilical cord may be gently slipped over the newborn’s head. If it cannot be moved easily, follow local protocols.
Never pull forcefully on the newborn or umbilical cord.
Newborn Assessment and Care
Most newborns begin breathing spontaneously and require only routine care.
Initial newborn care includes:
- Drying and warming the newborn.
- Assessing breathing, muscle tone, and heart rate.
- Providing gentle stimulation when necessary.
- Maintaining skin-to-skin contact with the parent when appropriate.
Routine suctioning is unnecessary unless secretions obstruct the airway.
For a stable newborn who does not require immediate resuscitation, current guidelines support delaying umbilical cord clamping for at least 60 seconds when feasible.
Newborn Resuscitation
If a newborn is not breathing, is gasping, or has a heart rate below 100 BPM after initial care, begin assisted ventilation promptly.
The recommended neonatal ventilation rate is 30–60 breaths per minute. An increasing heart rate is an important sign that ventilation is effective.
If the newborn’s heart rate remains below 60 BPM despite effective ventilation and appropriate corrective steps, chest compressions and additional resuscitation measures may be necessary under neonatal resuscitation protocols.
The APGAR score, assessed at one and five minutes after birth, evaluates appearance, pulse, grimace, activity, and respiration. Scoring must never delay necessary resuscitation.
Childbirth Complications
EMTs should recognize several complications that require urgent medical care.
Breech Presentation
A breech presentation occurs when the newborn’s buttocks or feet present before the head. Request additional assistance and arrange rapid transport when possible.
Prolapsed Umbilical Cord
A prolapsed cord occurs when the umbilical cord descends ahead of the presenting part of the fetus. Pressure on the cord can interrupt oxygen delivery.
Request immediate assistance, relieve pressure on the cord using authorized techniques, and arrange rapid transport. Do not attempt to push the cord back into the vagina.
Postpartum Hemorrhage
Excessive bleeding after childbirth can cause life-threatening shock.
Monitor circulation, provide appropriate supportive care, and transport promptly. Fundal massage may be indicated under local protocols.
Pediatric Patient Assessment
Children have important anatomical and physiological differences from adults.
- Infants and children generally have faster heart and respiratory rates.
- Their smaller airways can become obstructed more easily.
- Children may maintain normal blood pressure until shock becomes severe.
- Young children lose body heat more rapidly.
EMTs use the Pediatric Assessment Triangle (PAT) to quickly recognize potentially serious conditions.
| Component | What to Assess |
| Appearance | Muscle tone, interaction, responsiveness, and behavior |
| Work of Breathing | Retractions, nasal flaring, abnormal sounds, and breathing effort |
| Circulation to the Skin | Pallor, mottling, and cyanosis |
Common pediatric emergencies include respiratory distress, seizures, dehydration, allergic reactions, and trauma.
Warning signs include increased breathing effort, altered responsiveness, cyanosis, and signs of shock.
Children can deteriorate rapidly when breathing becomes inadequate. Use age-appropriate equipment and involve parents or caregivers when appropriate.
Geriatric and Special Patient Care
Geriatric Patients
Older adults may have multiple chronic conditions, take several medications, and have reduced physiological reserves.
Serious illnesses may also produce less typical symptoms. For example, an older adult having a heart attack may report weakness or shortness of breath without chest pain.
A sudden change in mental status should never be dismissed as a normal part of aging.
Patients With Special Healthcare Needs
Some patients rely on wheelchairs, communication devices, feeding tubes, oxygen equipment, or other medical devices.
When treating these patients:
- Communicate directly with the patient whenever possible.
- Ask caregivers about the patient’s normal condition.
- Identify changes from the patient’s usual baseline.
- Protect necessary medical equipment during treatment and transport.
- Adapt communication and assessment techniques appropriately.
Always treat patients respectfully and avoid making assumptions about their abilities.
Key Tip
Adapt your assessment to the patient’s age, condition, and medical needs. Recognize signs of imminent childbirth, know when a newborn needs ventilation, and remember that children may develop serious respiratory or circulatory problems before obvious deterioration occurs. Immediate life threats always remain the priority.