Position regarding Bimanual Uterine Compression

Q.The JRCALC guidelines state that it is only to be carried out by those paramedics who have received appropriate training. Does this mean JRCALC consider this a paramedic only skill, given the potential for non-registered clinicians to be unable to use drug therapy so have this as only of their only options in a time critical situation?

A. At the current time, this is a highly invasive procedure and therefore sits within the scope of a paramedic as an advanced skill.

Q. What is appropriate training in the view of JRCALC? This was covered in our university teaching but with the caveat that it was unclear whether this counted as sufficient training for JRCALC purposes, while another recent CPD day I went on covered it briefly and felt this did meet the JRCALC criteria. It seems to be highly variable among trusts and organisations and even then different views seem to exist within organisations, so it would benefit from national guidance to clarify.

A. The use of bimanual uterine compression is rarely required for the management of primary post-partum haemorrhage, due to uterine atony. For skilled maternity clinicians, this is only carried out once a range of other interventions are used, namely, uterine massage, administration of drugs, and emptying of the urinary bladder are undertaken and unsuccessful. Midwives and obstetricians are familiar with undertaking vaginal examinations as this skill forms part of their pre-registration training. The skill of bimanual uterine compression is one that requires an understanding of the female anatomy, and how to understand what to expect in regards to the changes once this method of uterine haemostasis takes place. Whilst it is invasive to the woman, it is also painful for the women. For a registered clinician to have a skill requires frequent practice and as such, the frequency of a paramedic being exposed to the need to undertake the procedure, or demonstrate a level of competency, is highly unlikely. The skill, therefore, requires each individual ambulance trust to consider whether it requires its employees to undertake this in an emergency. It may well be undertaken by paramedics with advanced or extended roles where they are more likely to be dispatched to obstetric emergencies or birth imminent calls.