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Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics
  1. Laura Goodwin1,
  2. Sarah Voss1,
  3. Graham McClelland2,3,
  4. Emily Beach1,
  5. Adam Bedson4,
  6. Sarah Black5,
  7. Toity Deave1,
  8. Nick Miller1,
  9. Hazel Taylor6,
  10. Jonathan Benger1
  1. 1School of Health and Social Wellbeing, University of the West of England, Bristol, UK
  2. 2Research and Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
  3. 3Stroke Research Group, Newcastle University School of Population and Health Sciences, Newcastle upon Tyne, UK
  4. 4EPRR/Specialist Practice, South Western Ambulance Service NHS Foundation Trust, Taunton, Somerset, UK
  5. 5Research and Audit, South Western Ambulance Service NHS Foundation Trust, Exeter, Devon, UK
  6. 6Research Design Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Laura Goodwin, School of Health and Social Wellbeing, University of the West of England, Bristol, UK; laura.goodwin{at}uwe.ac.uk

Abstract

Background Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics.

Methods A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA.

Results There were 1582 ‘normal deliveries’ attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5°C. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement.

Conclusions This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement.

  • emergency ambulance systems
  • obstetrics
  • hypothermia
  • clinical assessment

Data availability statement

Data are available on reasonable request. The datasets generated and analysed during this study are not publicly available due to participant confidentiality, but are available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. The datasets generated and analysed during this study are not publicly available due to participant confidentiality, but are available from the corresponding author on reasonable request.

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Footnotes

  • Handling editor Caroline Leech

  • Twitter @laurakgoodwin, @mcclg

  • Contributors LG was the Chief Investigator/guarantor with overall responsibility for the study, and participated in study conception, design and coordination, performed and coded the interviews, analysed the data and drafted the manuscript. SV and TD participated in study conception, design and interpretation of the results, and supported qualitative data analysis. HT participated in study conception, design and interpretation of the results, and supported quantitative data analysis. GM, EB, AB, SB, NM and JB participated in study conception, design and interpretation of the results. All authors were responsible for the critical revision of the manuscript for publication and approved the final version to be published.

  • Funding This study was supported by a Vice Chancellor’s Early Career Researcher Development Award from the University of the West of England, Bristol (VCECRF2020).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.