The Pregnant MVA Victim

A third-term pregnant woman in a traumatic event is a potential crisis even if no immediate threats to life are identified.

     Attack One responds to a report of an auto accident, with one of the patients being pregnant. On scene, the crew finds an unusual accident with one vehicle submarined under the other. There is significant damage to the lower vehicle, with the upper auto penetrating its windshield. A quick assessment notes five victims: two in the lower vehicle, two in the upper vehicle and one who's been ejected from the upper vehicle. The victims in the lower vehicle will require some minor extrication.

     Personnel from the first-arriving engine stabilize both vehicles and provide a charged hose line for any potential fire, as well as perimeter control and an entrance pathway for heavy-rescue assets. The triage operation is carried out quickly, as there is relatively less injury to all patients than was anticipated from the mechanism of the accident. The ejected victim is alert and talking and complains of leg and arm pain without obvious deformity. The driver in the upper car has neck pain and lacerations. The upper car's front-seat passenger is a 25-year-old female who is approximately 38 weeks pregnant. She is still in her seat and shoulder harness and says she's not injured, just too scared to move. The victims in the lower vehicle complain of neck pain and have extensive lacerations. The Attack One crew controls bleeding in both.

     The crew calls for a total of three medic units for transport. Based on her request, the pregnant female will be transported separately to the hospital that had provided her prenatal care.

     The victim on the ground was ejected through a side window and landed in a grassy area, with injuries to her left arm and leg. No other injuries are noted. She can be quickly packaged and placed in the transport medic unit.

     The pregnant upper-vehicle passenger, still denying any pain, is immobilized and lowered from the vehicle to the medic unit. The driver of the upper car is immobilized on a short board and brought down a ladder. Those three patients are then removed from the scene as patients in the lower automobile are extricated.

     The pregnant woman smiles and converses with the crew as she's placed in the medic unit that will transport her. She is packaged quickly on a backboard and rolled onto her left side, where she says she's comfortable. This is her first pregnancy, and her obstetrician has estimated she has one more week until delivery. She's been through an unremarkable pregnancy to date, and was out with her friends to shop for some baby items. She'd felt the baby moving quite a bit over the last week. The woman says she always wears her seat belt low over her pelvis, as her doctor told her.

     Her vital signs are taken and found to be normal, except for a pulse oximetry reading of 94%. The facility to which she requested transport-where her obstetrician practices and her prenatal files are located-is a community hospital that does not provide trauma services.

     As the paramedic prepares to place an oxygen cannula on her, the patient's expression suddenly changes, and she says she's having severe abdominal cramping. Her pulse rate increases rapidly, and her pulse oximetry value drops into the 80s. "I think I'm going to die!" she gasps.

     The medic requests an immediate change in destination to the regional trauma center, which is at least 10 minutes closer than the originally requested hospital and, fortunately, has an outstanding labor unit and a high-level neonatal intensive care service. The change in destination is explained to the patient. Her clinical condition is changing dramatically, her abdomen now rigid, and she is pale and quiet. She maintains the left-side position, receiving oxygen by mask and a liter bolus of fluid by large-bore intravenous line. The paramedic makes a crisis call to the trauma center, requests the emergency physician and relays the patient information. He asks a key question: "Where do we take her, to the ED or the Labor and Delivery area?"

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