Salt Spring’s emergency responders worked toward a rather specialized sense of shared confidence and community this month, as fire and rescue teams joined island paramedics, midwives and doulas to practise newborn “stabilization and transfer” scenarios Thursday, June 4.
The drills were cooked up and “performed” with collaboration from the Salt Spring midwives and doulas, who set scenes for search and rescue, fire and ambulance teams — any one of which might find themselves first through the door during a birth emergency. Ali Lopez is the Rural Obstetrics and Maternity Sustainability Program (ROAM) coordinator for Salt Spring Island, and said these program-funded training sessions help get first responders comfortable with the possibility they very well might be the one supporting a baby and family when things don’t go as planned.
Last year there were 22 births on Salt Spring, according to data from the Rural Coordination Centre of B.C., and given the island’s unique rural realities just eight of those took place at Lady Minto Hospital. Coupled with the knowledge there were nearly 90 pregnant families on-island in the care of a midwife last year, health officials recognized it was an excellent use of resources to “train up” everyone they could, from Salt Spring Island Search and Rescue (SSISAR) to the Coast Guard, to be ready to walk into anything.
“A lot of people don’t even know that births still take place on the island,” said Lopez. “On Salt Spring much of the time, it’s a home birth — and you never know it’s an emergency until it is, so our fire and ambulance crews might be the first ones there.”
Thursday’s event took place in the deliberately cramped quarters of SSISAR’s building on Fulford-Ganges Road; home births happen is all sorts of homes, and there’s no guarantee there will be plenty of room. During the scenarios, surprise curve balls — like the possibility of a second family member having their own medical emergency during the birth — brought a little measured chaos to the training, as first responders stepped over and around one another to deliver care — and just as importantly, comfort.
“We’re really building community by working together, knowing each other and their style of work,” said Lopez. “Being familiar with other professionals you might work with, it makes a stressful situation less uncomfortable knowing we’re all one team.”
The approach of the ROAM program is to develop community-specific plans that focus on team building and an all-community response; with two ambulances to cover the length and breadth of Salt Spring, it’s not difficult to imagine a situation where they’d be tied up elsewhere. In one of the day’s scenarios, Salt Spring Island Fire Rescue firefighters were first to an improvised scene, where the expectant mother found herself going into labour just as her partner’s mother seemed to be at increasing risk of a heart attack. Sarah Carey is the program’s clinical lead and has been a midwife for more than 20 years; she said as a coordinator it’s sometimes hard to come up with scenarios that can really compare to the unique birth experiences that happen on the island.
“You talk to a midwife — or any first responder — and we all have stories of things other people would not believe,” said Carey, who also teaches neonatal resuscitations. “Because we have such a high proportion of home births here on Salt Spring — somewhere between 50 and 80 per cent, and some months it’s 100 per cent — fire and ambulance and our whole community, they are all a part of it.”
After each scenario, the group debriefed; in addition to skills training on particular medical conditions to be aware of for expectant and brand-new mothers and their babies, the doula “actors” brought feedback and reflection on how they felt cared for.
“It’s been really beneficial with the state of births on the island,” said Lopez. “The better they’re prepared to handle whatever they walk into, the more ideal for everyone involved.”