Fall 2009
Stand and Deliver

synapse: University of Nevada, Reno School of Medicine

Thomas Hunt instructs Margaret Russell

Thomas Hunt, M.D., right, instructs Margaret Russell, M.D., on proper techniques for vacuum-assisted deliveries. Course instructors use maternal-fetal mannequins for hands-on practical experience. Photo by Anne McMillin.

Obstetrics Training in Rural Nevada

Story by Anne McMillin, APR

Taught by faculty and residents of the school’s family and community medicine, and obstetrics and gynecology departments, an advanced practical nurse from the University of Nevada, Las Vegas and military physicians from Nellis Air Force Base, the two-day course has been offered twice in the past year to health care professionals across the state.

“Our goal is to train as many Nevada health care providers as possible right here in our state and have them all trained the same way,” said Elissa Palmer, M.D., chair of the School of Medicine’s Department of Family and Community Medicine in Las Vegas, who coordinates, directs and teaches the program. “This course is designed for maternity care providers or those who might have to deliver a baby in an emergency.”

This course, dubbed ALSO, is designed to enhance the skills of physicians and other health care providers to manage potential obstetrical urgencies and emergencies effectively. It emphasizes labor and delivery room emergencies but also covers prenatal risk assessment, first-trimester complications, miscarriages, assisted deliveries, vaginal bleeding in late pregnancy, risk factors for preterm labor, consultant relationships, patient safety and information on reducing medical malpractice risk. Instruction is given through a series of lecture presentations and hands-on practicum sessions using maternal-fetal mannequins.

The course offers participants the opportunity to test and become certified as an ALSO provider.

Kate Martin, M.D.’06, current faculty member of the Department of Family and Community Medicine in Las Vegas, was wrapping up her final months as chief resident during the class this spring and is now a certified instructor.

After participating in the course as a student last fall in Las Vegas, she attended the instructor’s course in Philadelphia and returned as an instructor candidate to teach the required two courses.

“It is a one-year process from ALSO student to instructor,” said Martin. “As a resident I probably did 150 deliveries so I have lots of experience, but this class gives me the formal training.”

According to Palmer, many critical factors contribute to the large number of medical emergencies and complicated deliveries of newborns in Nevada, including the high costs of malpractice insurance, shortages of physicians in rural areas, distances rural women must travel for maternity care and increasing minority populations who are often unable to seek timely obstetric care.

Standardized training in the management of emergency obstetrical situations can significantly increase patient’s access to safe, quality care in Nevada’s rural communities. This training for family medicine physicians, obstetricians, obstetrical nurses, nurse midwives and emergency personnel, including emergency medical technicians and flight staff, can improve their ability to respond to emergencies in obstetrical care. The training can also better prepare rural emergency medicine and primary care physicians to deal with unexpected problems and stabilize patients.

The course in Sparks this spring drew 31 participants from Winnemucca, Wells, Reno, Sparks and Hawthorne. But the program’s geographic reach did not stop at the Nevada state line, as attendees came from several western states including Colorado, Washington and California. Some course participants were sent by their employers while others attended on their own time, but each cited different reasons for attending.

Midwife Annette Kirby, who is rejoining her profession after teaching at the U.S. Air Force Academy in Colorado Springs, Colorado, will practice midwifery in the United Arab Emirates this fall as she follows her husband to his next military duty station.

“I wanted to brush up on my clinical skills and learn the language of obstetrics in English,” said the Danish native. “I want to stay on top of my field and not get stuck in old routines.”

Margaret Russell, M.D., a graduate of the school’s family medicine residency program, who practices in Yerington and Smith Valley, took the course to recognize obstetrical problems and learn what equipment is needed at the South Lyon Medical Center where she treats patients.

Michael Keep, M.D., chief family medicine resident at Providence St. Peter Hospital in Olympia, Wash., said the review of practical obstetrics skills, especially the vacuum-assisted delivery, was valuable to him.

“I will now know when something is going badly and intervention is needed,” he said.

Kenneth Yazzie is a volunteer emergency medical technician in Elko County. “I may find myself in the circumstance of transporting a woman in labor and in case I have to do the delivery, I want a better edge and to get my skills up.”

Started with a two-year grant of $200,000 through the Nevada State Health Division Trust Fund for Public Health, the ALSO program is now self-supporting. Palmer is exploring additional grant funding to expand course offerings statewide, establish an ALSO instructor course in Nevada and add more courses in obstetrical care and patient safety under development by the American Academy of Family Physicians and the Department of Defense, respectively.