Over the last 24 years, the course has naturally evolved, as has our specialty. In recognition of this, acknowledging the recent national changes in trauma management, as well as the increasing number of medical complexities that we are all seeing in our local units, MOET wanted to change too. By developing the trauma aspect and maternal medicine content, we hope to improve care delivered by Obstetricians and Anaesthetists working on the front line with our Midwifery colleagues.
Teaching around pre‐eclampsia and haemorrhage has been prioritised over the last few decades and maternal death from these causes has fallen accordingly. Now we need to address the new medical complications and emergencies that we are all experiencing in our day‐to‐day working lives. Recent MBRRACE‐UK reports reveal that cardiac disease, thromboembolism and neurological disease are now the three leading causes of maternal deaths. Subsequently, MOET became mMOET to acknowledge that we are ‘Managing Medical and Obstetric Emergencies and Trauma’ and to address these challenges.
We have worked with our colleagues in the emergency services and thoroughly rejuvenated the trauma content of the course. Being called to your ED in the middle of the night to a pregnant trauma victim can be daunting. We hope that this manual will help prepare you, to understand what your role is within the attending Trauma team and give you the confidence to acknowledge how you can contribute to the vital emergency care that the patient requires with your very specialised knowledge. If we can help give you the tools needed to address the next emergency you have to tackle, then we will have achieved what we set out to do.
To all the current and future generations of Obstetricians and Anaesthetists, we hope this manual and the mMOET course will inspire you to keep learning, to do your very best in some of the most difficult situations and to give our women and their babies the highest quality of care.
Kara Dent and Rosamunde BurnsMay 2022
Acknowledgements
A great many people have put a lot of hard work into the production of this book and the accompanying course. The editors would like to thank all the contributors for their efforts and all the mMOET providers and instructors who took the time to send their comments during the development of the text and the course.
Some of the material used in this text is from other Advanced Life Support Group (ALSG) publications, in particular from the books Advanced Paediatric Life Support: The Practical Approach, Neonatal, Adult and Paediatric Safe Transfer and Retrieval: The Practical Approach and Major Incident Medical Management and Support: The Practical Approach in the Hospital.
The chapters on resuscitation have been informed by the new international guidelines produced by an evidence‐based process from the collaboration of many international experts under the umbrella of the International Liaison Committee on Resuscitation (ILCOR, 2020).
We would also like to thank members of our mMOET Trauma Review Group for all of their work in reviewing and updating the trauma section:
| Rosamunde Burns | MBChB FRCA, Consultant Anaesthetist, Royal Infirmary of Edinburgh; Honorary Senior Lecturer, University of Edinburgh |
| R. John Elton | FRCA Consultant Obstetric Anaesthetist, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry |
| Kyle Gibson | MRCP FRCA FFICM, Specialty Trainee in Anaesthesia and Intensive Care Medicine, South East Scotland |
| Brigid Hayden | FRCOG, PGCTLCC, DMCC Consultant Obstetrician and Gynaecologist, Labour Ward Lead, Princess Elizabeth Hospital and Medical Specialist Group, Guernsey |
| Audrey Jeffrey | FRCA Consultant Anaesthetist, St John’s Hospital, Livingston |
| Dean Kerslake | FRCP FRCEM EDIC FFICM, Consultant in Emergency Medicine and Critical Care. Clinical Director for Major Trauma, Royal Infirmary of Edinburgh |
| Darren Walter | MPH FRCS FRCEM FIMC FAEMS Senior Lecturer in Emergency Global Health, University of Manchester, Honorary Consultant in Emergency Medicine, Manchester University NHS Foundation Trust |
| Arlene Wise | FRCA Anaesthetic Consultant, NHS Lothian |
We would like to thank Catherine Giaquinto for the algorithm design, and Helen Carruthers and Kate Wieteska for their work on many of the line drawings within the text. We would also like to thank the following organisations for the shared use of their figures, tables and algorithms:
Alma Medical
American Journal of Obstetrics and Gynecology
Arrow
Association of Anaesthetists
COBIS
Difficult Airway Society (DAS)
Freelance Surgical
MBRRACE‐UK
Northern Neonatal Network
Obstetric Anaesthetists’ Association (OAA)
Omega Healthcare
Resuscitation Council UK
Royal College of Physicians
Scottish Patient Safety Programme Maternity and Children Quality Improvement Programme
The American Civil Defense Association (TACDA)Victoria Health
VBM
Wiley
World Health Organization
We also thank the BMJ for the Trauma Timeline, Laura May for the TRAUMATIC mnemonic, Tim Nutbeam and Ron Daniels on behalf of the UK Sepsis Trust, and Gareth Owens on behalf of the ‘Think Aorta’ Campaign for kindly sharing their resources.
We would like to thank, in advance, those of you who will attend the Managing Medical Obstetric Emergencies and Trauma (mMOET) course and others using this text for your continued constructive comments regarding the future development of both the course and the manual.
Contact details and further information
ALSG: www.alsg.org
For details on ALSG courses visit the website or contact:
Advanced Life Support Group
ALSG Centre for Training and Development
29–31 Ellesmere Street
Swinton, Manchester
M27 0LA
Tel: +44 (0) 161 794 1999
Fax: +44 (0) 161 794 9111
Email: [email protected]
Updates
The material contained within this book is updated on approximately a 4‐yearly cycle. However, practice may change in the interim period. We will post any changes on the ALSG website, so we advise you to visit the website regularly to check for updates (www.alsg.org).
References
To access references visit the ALSG website www.alsg.org – references are on the course pages.
On‐line feedback
It is important to ALSG that the contact with our providers continues after a course is completed. We now contact everyone 6 months after his or her course has taken place asking for on‐line feedback on the course. This information