Abstract：
BACKGROUND: Unplanned out-of-hospital births represent less than 1% of ambulance requests for assistance. However, these call-outs have a high risk of life-threatening complications, which are particularly complex in rural or remote settings with limited accessibility to specialist care support. Many community hospitals no longer provide obstetrics care, so birth parents must travel to larger regional or metropolitan hospitals for assistance. Increased travel time may increase the risk of unplanned out-of-hospital birth and/or complications such as postpartum haemorrhage and neonatal mortality. Rural volunteer ambulance officers (VAOs) are an integral component of Australia\'s healthcare system, especially in regional and remote areas. Although VAO response to unplanned out-of-hospital births may be considered rare compared to calls to other case types, provision of adequate care is paramount in these potentially high-risk situations. This research investigates Australian rural VAOs\' perceptions of their training, experience and confidence regarding unplanned out-of-hospital birth and planned homebirth with obstetric emergencies where ambulance assistance is required.
METHODS: Semi-structured interviews and focus groups were undertaken from late 2021 to mid-2023 via telephone or online videoconference. Sessions were audio-recorded and transcribed verbatim. Data were analysed and coded into themes using Braun and Clarke\'s six-step process for semantic coding and reflexive thematic analysis.
RESULTS: Twenty-eight participants were interviewed from six Australian states and territories, all of whom worked in rural and remote Australia. Ten participants were male, 17 female and one was male-adjacent, with length of VAO experience ranging from 3 months to 29 years. Participants came from seven jurisdictional ambulance services.| Four themes emerged from analysis: (1) Lack of education and exposure to birth resulted in low confidence. Most participants reported significant anxiety attending obstetric call-outs, and explained under-utilisation of specific obstetric and neonatal skills meant skills decay was an issue; (2) limitations were discussed regarding VAO scope of practice and accessing medical equipment specifically required for birthing and neonates that could impact patient care; (3) logistical and communication difficulties were discussed. Long distances to definitive care, potentially limited backup during emergencies and potential unavailability of aeromedical retrieval increased perceived complexity of cases. Telecommunication \'black holes\' created a sense of further isolation for VAOs requiring support from senior clinicians; (4) there was a perception that many members of the general public were unaware VAOs often staffed the local ambulance, and expected VAOs to have the same scope of practice as a registered paramedic. Furthermore, VAOs can attend friends and family in an emergency, potentially creating psychological trauma.
CONCLUSIONS: VAOs report being uncomfortable attending unplanned out-of-hospital births and obstetric emergencies, perceiving they have limited ability to manage complications. Backup from a registered paramedic is dependent on availability, and telecommunications are not always reliable in rural areas for online clinical advice and support. Given the distances to definitive care in regional Australia, this has serious implications for patient safety. Continued VAO education is essential for risk reduction in out-of-hospital births.
METHODS: Semi-structured interviews and focus groups were undertaken from late 2021 to mid-2023 via telephone or online videoconference. Sessions were audio-recorded and transcribed verbatim. Data were analysed and coded into themes using Braun and Clarke\'s six-step process for semantic coding and reflexive thematic analysis.
RESULTS: Twenty-eight participants were interviewed from six Australian states and territories, all of whom worked in rural and remote Australia. Ten participants were male, 17 female and one was male-adjacent, with length of VAO experience ranging from 3 months to 29 years. Participants came from seven jurisdictional ambulance services.| Four themes emerged from analysis: (1) Lack of education and exposure to birth resulted in low confidence. Most participants reported significant anxiety attending obstetric call-outs, and explained under-utilisation of specific obstetric and neonatal skills meant skills decay was an issue; (2) limitations were discussed regarding VAO scope of practice and accessing medical equipment specifically required for birthing and neonates that could impact patient care; (3) logistical and communication difficulties were discussed. Long distances to definitive care, potentially limited backup during emergencies and potential unavailability of aeromedical retrieval increased perceived complexity of cases. Telecommunication \'black holes\' created a sense of further isolation for VAOs requiring support from senior clinicians; (4) there was a perception that many members of the general public were unaware VAOs often staffed the local ambulance, and expected VAOs to have the same scope of practice as a registered paramedic. Furthermore, VAOs can attend friends and family in an emergency, potentially creating psychological trauma.
CONCLUSIONS: VAOs report being uncomfortable attending unplanned out-of-hospital births and obstetric emergencies, perceiving they have limited ability to manage complications. Backup from a registered paramedic is dependent on availability, and telecommunications are not always reliable in rural areas for online clinical advice and support. Given the distances to definitive care in regional Australia, this has serious implications for patient safety. Continued VAO education is essential for risk reduction in out-of-hospital births.
摘要：
背景：计划外分娩占救护车援助请求的不到1%。然而,这些呼叫有很高的危及生命的并发症的风险，这在农村或偏远地区特别复杂，获得专科护理支持的机会有限。许多社区医院不再提供产科护理，因此，亲生父母必须前往较大的地区或大都市医院寻求帮助。旅行时间的增加可能会增加计划外分娩和/或并发症如产后出血和新生儿死亡的风险。农村志愿救护人员（VAO）是澳大利亚医疗保健系统的组成部分，特别是在区域和偏远地区。尽管与其他病例类型相比，VAO对计划外分娩的反应可能被认为是罕见的，在这些潜在的高风险情况下，提供足够的护理至关重要。这项研究调查了澳大利亚农村VAO对他们训练的看法，在需要救护车援助的产科紧急情况下，关于计划外分娩和计划性家庭分娩的经验和信心。
方法：从2021年底到2023年中期，通过电话或在线视频会议进行了半结构化访谈和焦点小组。会议是录音和逐字转录的。使用Braun和Clarke的语义编码和反身主题分析的六步过程对数据进行了分析并编码为主题。
结果：来自澳大利亚六个州和地区的28名参与者接受了采访，他们都在农村和偏远的澳大利亚工作。十名参与者是男性，17名女性和1名男性相邻，VAO经验长度从3个月到29年不等。参与者来自七个有管辖权的救护车服务。|分析中出现了四个主题：（1）缺乏教育和对出生的接触导致信心低下。大多数参与者报告了在产科呼叫中出现的严重焦虑，并解释了特定产科和新生儿技能的未充分利用意味着技能下降是一个问题;(2)讨论了VAO实践范围和获取分娩和新生儿特别需要的医疗设备的限制,这些限制可能影响患者护理;(3)讨论了后勤和沟通困难。长途跋涉到最终的护理，紧急情况下潜在的有限备份和航空医学检索的潜在不可用增加了病例的感知复杂性。电信“黑洞”为需要高级临床医生支持的VAO造成了进一步孤立的感觉；（4）有一种看法，即许多公众不知道VAO经常为当地救护车配备人员，并期望VAO具有与注册护理人员相同的执业范围。此外，VAO可以在紧急情况下照顾朋友和家人，有可能造成心理创伤.
结论：VAOs报告说，在非计划的院外分娩和产科急诊就诊时感到不舒服，认为他们管理并发症的能力有限。来自注册护理人员的备份取决于可用性，在农村地区，电信并不总是可靠的在线临床建议和支持。考虑到澳大利亚地区到最终护理的距离，这对患者安全有严重影响。持续的VAO教育对于降低院外分娩的风险至关重要。
方法：从2021年底到2023年中期，通过电话或在线视频会议进行了半结构化访谈和焦点小组。会议是录音和逐字转录的。使用Braun和Clarke的语义编码和反身主题分析的六步过程对数据进行了分析并编码为主题。
结果：来自澳大利亚六个州和地区的28名参与者接受了采访，他们都在农村和偏远的澳大利亚工作。十名参与者是男性，17名女性和1名男性相邻，VAO经验长度从3个月到29年不等。参与者来自七个有管辖权的救护车服务。|分析中出现了四个主题：（1）缺乏教育和对出生的接触导致信心低下。大多数参与者报告了在产科呼叫中出现的严重焦虑，并解释了特定产科和新生儿技能的未充分利用意味着技能下降是一个问题;(2)讨论了VAO实践范围和获取分娩和新生儿特别需要的医疗设备的限制,这些限制可能影响患者护理;(3)讨论了后勤和沟通困难。长途跋涉到最终的护理，紧急情况下潜在的有限备份和航空医学检索的潜在不可用增加了病例的感知复杂性。电信“黑洞”为需要高级临床医生支持的VAO造成了进一步孤立的感觉；（4）有一种看法，即许多公众不知道VAO经常为当地救护车配备人员，并期望VAO具有与注册护理人员相同的执业范围。此外，VAO可以在紧急情况下照顾朋友和家人，有可能造成心理创伤.
结论：VAOs报告说，在非计划的院外分娩和产科急诊就诊时感到不舒服，认为他们管理并发症的能力有限。来自注册护理人员的备份取决于可用性，在农村地区，电信并不总是可靠的在线临床建议和支持。考虑到澳大利亚地区到最终护理的距离，这对患者安全有严重影响。持续的VAO教育对于降低院外分娩的风险至关重要。
