Abstract
The initial care of neonates of unplanned out-of-hospital births is often done by paramedics, but an educational system related to perinatal care provided for paramedics has yet to be established. The objective of our study was to describe the neonatal outcomes of unplanned out-of-hospital births and to clarify the issues related to perinatal education for paramedics. From January 2008 to December 2018, a total of 40 neonates born out of hospital were transported to our hospital by paramedics. In 23 of those neonates（57.0％）, the paramedics attended the deliveries, whilst the remaining 17（43.0％）were born before the paramedics’ arrival. Although 32 of the neonates underwent only routine neonatal care after birth, five required resuscitations by positive pressure ventilation including one who also needed chest compressions. There were three neonatal deaths, in which two of the neonates had congenital disease and the other was born with severe asphyxia due to cervical umbilical cord winding and difficulty in delivery. An Apgar score by paramedics was registered in only 16 of the cases（40.0％）. Hypothermia, defined as a body temperature below 36 degrees Celsius, was present in 24 of the cases（60.0％）, and it was the most common neonatal complication, revealing the importance of out-of-hospital management of body temperature. Recently, more paramedics have taken classes in perinatal emergency; however, a training course that fully covers out-of-hospital births is still unavailable. To decrease neonatal morbidity and mortality, more practical educational courses on out-of-hospital births for paramedics that focus on the issues identified by this study should be established.
