We are excited to announce a community collaboration that aims to enhance maternal healthcare and improve outcomes in underserved areas across the state of Arizona.

Arizona Emergency Medical Systems (AEMS) and the Arizona Perinatal Trust (APT) have partnered with researchers from the University of Connecticut Health (UConn) to launch a groundbreaking Obstetric Life Support (OBLS) Training Initiative and Study with the aim of improving and elevating the capabilities of healthcare providers working in Hospitals/Birth Centers AND Prehospital/EMS.

Maternal healthcare in the United States remains a critical concern, with the country grappling with the highest maternal mortality rate among developed nations. Shockingly, approximately 1200 women lose their lives each year due to preventable pregnancy-related complications. This alarming statistic underscores the urgency of addressing health disparities that disproportionately impact certain communities.

AEMS' role is to identify Prehospital/EMS participants for the trainings, while API will identify the Hospital/Birth Center Participants. Our shared goal is to ensure that healthcare professionals across the state, especially in areas with scarce or limited maternal care facilities, possess the expertise and resources necessary to effectively respond to maternal and childbirth emergencies.

Statewide Trainings Coming 2025

During 2025, the 6-hour OBLS simulation training course will be scheduled at Hub sites throughout Arizona. To be considered for this training, you must complete the Interest Form, as it serves as the initial step in identifying Prehospital/EMS providers interested in receiving OBLS® training. Priority will be given to those who express interest in becoming instructors.

Training is limited to only 16 participants per Hub site. Those selected will attend one of the 4-hour training courses. The Interest Form will help us assess and select the most appropriate individuals from around the state, with a focus on inclusiveness for those serving areas with the greatest need. Additionally, this form will allow us to create an OBLS database that will keep individuals updated about future trainings, education, and other valuable resources.

According to the American Association of Specialty Physicians, no specialty of medicine is more inundated with emergencies than obstetrics.  Moreover, the United States (U.S.) has the highest maternal mortality rate among developed countries. Approximately 1200 women die each year from pregnancy-related complications, and disproportionately impacts persons of color.

According to a 2022 report by the Centers for Disease Control, an estimated 84% of pregnancy-related deaths in 36 states between 2017 and 2019 were preventable. Per this report, the six most frequent underlying causes of pregnancy-related death:

• mental health conditions (22.7%)
• hemorrhage (13.7%)
• cardiac and coronary conditions (12.8%)
• infection (9.2%)
• thrombotic embolism (8.7%)
• cardiomyopathy (8.5%)

According to a Public Health Data Report compiled by the March of Dimes:

• 36% of counties nationwide constitute "maternity care deserts”
• Rural women have a 39% higher maternal mortality ratio compared with women living in large metropolitan counties (23.8 vs. 14.6 per 100,000 live births) ⁽⁷⁾, and black women experience three times more deaths than White women (59.3 versus 19.7 deaths per 100,000 live births).
• Six of 15 counties in Arizona have limited access to (level I or II centers) or no maternal care
• 50% of counties in Arizona have a high Maternal Vulnerability Index, the first county-level, national-scale tool to identify where and why moms in the US are vulnerable to poor pregnancy outcomes and pregnancy-related deaths.

These statistics underscore the significance of ensuring that healthcare providers, particularly those involved with Prehospital/EMS, possess the expertise and resources necessary to effectively respond to maternal and childbirth emergencies. While most pregnancy-related issues allow time for proper management, a few can escalate into life-threatening scenarios, where a successful outcome hinges on immediate and highly skilled intervention. Despite published guidelines, there is currently no accessible standardized training available for addressing maternal medical emergencies and maternal cardiac arrest.

AZ MATERNITY CARE REPORT

The OBLS training initiative comprises the following key components:

1. The Obstetric Life Support™ (OBLS) Course. This simulation training program is designed to bridge the knowledge gap in handling maternal medical emergencies, including cardiac arrest. The training consists of completing an online learning prep course (estimated 2-3 hours to complete) and a 6-hour simulation resuscitation course. Participants will also be asked to complete an online survey 6-months after the course.

NOTE: IF you pass the OBLS Course and meet the other eligibility and performance requirements, you may be selected to take the Instructor course. The Instructor (Train-the-Trainer) course is a four hour online training that consists of debriefing, simulation, and train-the-trainer components.   There is a cost to taking this course, but it will be covered by the grant.

2. Train-the-Trainer. A Train-the-Trainer component is offered for those interested in teaching the OBLS course to colleagues and stakeholders in their area. To be eligible for this Instructor training, participants must successfully complete the OBLS training Course, and receive a required recommendation by an OBLS instructor. Notably, there is a high likelihood (60%) of being recommended as an Instructor if performance and test requirements are met.
   
   
3. Teaching of OBLS Courses. Those participants who become Instructors will be expected to train colleagues and stakeholders in their area.   Instructors will receive resources and mentoring by an experienced OBLS instructor.
   
   
4. Evaluation. This training initiative is a study funded by a grant, and as such, pre and post-surveys will be implemented throughout the process to evaluate its impact.   Participants are expected to participate in the evaluations. 

COURSE SUMMARY OVERVIEW

In response to the challenges faced by Arizona in maternal healthcare, particularly in addressing maternal cardiac emergencies among women, UConn has secured a substantial $1.9 million grant from the National Institute of Health (NIH) to develop Obstetric Life Support (OBLS), a comprehensive simulation-based resuscitation program.

This grant training initiative and study are dedicated to improving the management of maternal medical emergencies, particularly those that may result in cardiac arrest and unfavorable outcomes. This statewide initiative is designed to address underserved areas with at-risk populations, especially those experiencing limited or insufficient maternity care, often referred to as maternity deserts. The primary goal is to expand the reach of OBLS in an equitable manner, utilizing a train-the-trainer approach across various medical settings in Arizona.

A pilot study has demonstrated that OBLS™ significantly boosts the confidence and knowledge of healthcare professionals in clinical competencies, both in hospital and prehospital settings. Furthermore, a randomized control trial has shown substantial improvements in knowledge and megacode scores among individuals trained with OBLS™ compared to control groups.

AEMS plays a pivotal role in identifying eligible Prehospital/EMS professionals statewide who may be interested in participating in these trainings, with the potential to becoming an Instructor.

To accomplish this, AEMS will:

• Closely collaborate with the Arizona Perinatal Trust.


• Confer and collaborate with the other three Arizona regional EMS Councils - Northern Arizona Emergency Medical Services (NAEMS), Southeastern Arizona Emergency Medical Services Council (SAEMS), and Western Arizona Council of Emergency Medical Services (WACEMS).


• Actively engage with other key stakeholders across the state, including the Arizona Department of Health Services (AzDHS) and the Arizona Center for Rural Health (AzCRH).

Together, we will work cooperatively to promote the statewide OBLS training initiative as well as identify the most appropriate Prehospital/EMS participants to attend.