A Community Partnership Initiative in Utah to Enhance Prehospital Perinatal Care in the Prevention of Postpartum Hemorrhage

Introduction In Utah, a confluence of factors over the last 10 years has led to an increase in prehospital births attended by emergency medical system (EMS) providers. Utah is a rural and frontier state where a large segment of the population lives far from obstetric care and where transport times to a facility for birth can be long or hazardous because of seasonal weather. Before March 2024, Utah EMS protocol guidelines only allowed paramedics to administer oxytocin and then only for the treatment of postpartum hemorrhage (PPH). In many cases, a paramedic is not available (because rural fire agencies are often staffed by volunteers, tight budgets do not support full paramedic coverage, or paramedics are not required), and thus, advanced emergency medical technicians (AEMTs) are first on the scene. A community‐based interprofessional quality improvement initiative was designed and implemented to expand state EMS protocol guidelines to address the timing, route and administrator of oxytocin. Process Using stepwise processes from Powell's Expert Recommendations for Implementing Change implementation science taxonomy, we combined bottom‐up and top‐down strategies, including stakeholder and decision‐maker interviews, community‐level focus groups, partner surveys, and coalition building to foster change. Outcomes In April 2024, the Utah EMS protocol guidelines were successfully changed to include the administration of oxytocin by paramedics for the prevention of PPH and to AEMTs for intramuscular prevention and treatment of PPH. Discussion This expansion of medication administration provides an additional tool to prevent PPH while increasing safety and equity of prehospital birth services. This may be particularly crucial in a rural and frontier state where maternity deserts, desire for community‐based birth, and obstetric‐care hurdles are increasing. It is hoped this quality improvement initiative can serve as a guide to others wanting to implement similar practice changes in their state.