Emergency Scenario 600_f2

Location Information

Full Location:

Hlíðarvegur 17, 600 Akureyri, Single-family home, built 1988. One story with basement, wooden construction with concrete foundation. Main entrance at street level with two steps. No security system. Driveway access from Hlíðarvegur. Current weather: 8°C, overcast, light wind, good visibility. GPS coordinates: 65.6762° N, 18.0978° W. Nearest landmark: Akureyri Hospital (FSA).

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: High-Risk Pregnancy Transfer

Priority Level: F2

Response Time Goal: 15-30 minutes

Description:

32-year-old female, 34 weeks pregnant, experiencing premature rupture of membranes (PROM). Patient reports clear fluid leakage since 06:00 this morning, with mild intermittent contractions every 10-15 minutes. No active bleeding reported. Patient is otherwise stable, alert and oriented. Medical history: Gestational diabetes, managed with diet. No known allergies. Medications: Prenatal vitamins. Last meal: Light breakfast at 07:00.

History of Events

Timeline:
06:00 hours: Patient noticed clear fluid leakage, suspected PROM.
06:00-08:00 hours: Patient monitored symptoms at home, mild contractions started.
08:00 hours: Patient contacted her midwife for advice, advised to go to hospital.
08:15 hours: Patient called emergency services for transport to Akureyri Hospital.
08:20 hours: Current time, patient is stable but anxious about PROM.

Diagnostics

Initial Assessment

Initial Impression: Premature Rupture of Membranes (PROM) at 34 weeks gestation.
Justification for F2 Classification:
- PROM at 34 weeks is considered a high-risk pregnancy complication due to the risk of infection, preterm labor, and potential fetal distress.
- Requires timely transport to a hospital with obstetric services for monitoring and potential intervention.
- Although not immediately life-threatening, the potential for rapid deterioration justifies urgent response.

Differential Diagnoses:
1. PROM (most likely)
2. Urinary incontinence (less likely given the reported fluid characteristics)
3. Vaginal infection (possible, but less likely to present with sudden fluid leakage)

Required Actions:
- Dispatch of ground EMS with ALS capabilities.
- Maternal vital sign monitoring (BP, HR, RR, SpO2) during transport.
- Fetal heart rate monitoring if available.
- Preparation for potential preterm labor and delivery at Akureyri Hospital.

Final Diagnosis

Final Diagnosis: Premature Rupture of Membranes (PROM) at 34 weeks gestation with early labor.
Key Findings:
- On arrival at hospital, confirmed PROM with amniotic fluid on examination.
- Patient was experiencing mild, but regular contractions (every 8 minutes).
- Fetal heart rate monitoring was normal. 
- No signs of infection present.
- Patient progressed to active labor within 6 hours and delivered a healthy preterm infant.

Outcome validated F2 priority assignment. Rapid transport to hospital allowed for prompt monitoring and intervention.

Learning Points:
1. F2 classification was appropriate for PROM at 34 weeks gestation.
2. Initial assessment accurately identified the need for urgent transfer.
3. Early recognition and transport are critical for positive outcomes in high-risk pregnancies.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I think my water broke, I'm 34 weeks pregnant.

Dispatcher Okay, I'm sending help. What is your address?

Caller It's Hlíðarvegur 17, in Akureyri.

Dispatcher Help is on its way. Can you describe the fluid?

Caller It's clear, not bloody. It started leaking about two hours ago. I'm having mild contractions too.

Dispatcher Are you having any pain or bleeding?

Caller No bleeding, just mild cramping. I have gestational diabetes, managed by diet.

Dispatcher Okay, the ambulance is on its way. Please stay calm and wait for them.

Caller Okay, thank you. I'm a bit worried but I'll wait.