A document analysis of clinical guidelines for the paramedic management of obstetric and neonatal presentations in Australian and New Zealand ambulance services

Introduction: Paramedics receive varying levels of training in obstetric presentations. In high-risk, low-frequency cases, clinical guidelines should support clinicians to deliver optimal care. This study analysed publicly available clinical guidelines for obstetric presentations published by ambulance services in Australia and Aotearoa New Zealand to determine consistency of clinical guidance and adherence to nationally recognised standards for the development and reporting of evidence-based guidelines. Method: Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised best practice standards. Results: Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent, not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence. Conclusion: This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.