When I am on scene and there is a pediatric patient needing resuscitation, what directive do I use, the Newborn Resuscitation or Cardiac Arrest Medical Directive?

There are instances when a firefighter or police officer may be the first responder on scene to a call that involves a pediatric patient or newborn in cardiac arrest.  A firefighter or police officer may be required to determine if this patient falls within the newborn category of resuscitation or the pediatric category.

As a reminder, in the Newborn Resuscitation Medical Directive a newborn is classified as a child less than 24 hours of age.

Indications for use:

Newborns less than 24 hours of age and in need of resuscitation

Conditions:

Age <24 hours

Contraindications:

Obvious death

Confirmed to be less than 20 weeks gestation by birthing parent, partner, etc.

Treatment

1. Assess newborn for the presence of meconium, breathing, crying, muscle tone, and colour.
2. If resuscitation required, clamp umbilical cord with 2 clamps and cut umbilical cord between the clamps.
3. Provide warmth, position, and clear the airway.
4. Dry, stimulate, and reposition the airway.
   5. Evaluate respirations, heart rate and colour.
5. Provide positive pressure ventilation if newborn is apneic or HR < 100.
6. If HR < 60 despite adequate oxygenation and ventilation, continue to provide positive pressure ventilation (with 100% FiO2) and administer chest compressions at a ratio of 3:1 (compression/ventilation).

Clinical Considerations

Pulse oximetry should not be utilized on a newborn as perfusion in the extremities for the first few minutes will be very poor.

 

It is important to remember that most newborns do not require any form of resuscitation.  For the patient population that does require resuscitation, most require only some ventilatory support via the BVM.  According to the America Heart Association, only 5-10% of all newborns need some sort of help with breathing from birth (PPV support with a BVM) and only 1% need advanced resuscitation (CPR).

Remember, If the patient is confirmed to be less than 20 weeks gestation, this medical directive does not apply and resuscitation should be withheld but, if there is any doubt by the  first responders on scene of the gestational age, then resuscitation should be started and continued until paramedics arrive on scene and take over patient care.