Roughly 300 babies are delivered outside hospitals each year in Connecticut, some intentionally and some not, and around 10% will need resuscitation. For the past year, Brooke Redmond, an assistant professor of pediatrics at Yale School of Medicine and medical director of the Waterbury Hospital neonatal intensive care unit, has offered hands-on training to emergency medical technicians (EMTs) in the Waterbury, Connecticut, area to help prepare them for such scenarios. Now, she’s created a new program that will allow her and other neonatologists to provide support during emergencies.
The program — 24/7 BABY — launched April 1 in the Waterbury area gives first responders access to neonatologist expertise 24 hours a day, seven days a week. The goal is to improve outcomes for babies born outside of a hospital setting by ensuring first responders have guidance when they most need it.
Redmond sat down with Yale News to talk about the challenges of unexpected births and how 24/7 BABY will help address them. This interview has been edited for length and clarity.
Brooke Redmond: I began providing training sessions on neonatology and pediatrics for the Waterbury emergency medical services (EMS) community, and I focused on deliveries in the field and how to manage neonatal emergencies that are occurring outside of a hospital. It was a really fun chance for me to open the conversation with how incredible babies are and how helpful certain actions can be to turn their circumstances around in a very short period of time.
The idea for the program came out of puzzling through what I might be able to do better to support the first responders after I’d done a couple of these sessions. I started to wonder if there was a way I could get eyes and ears on the scene directly. I began exploring some of the telehealth options we had used during the pandemic to see if we could get telehealth in the field in real time.
A lot of people helped make it happen, and we’re now launching the program in Waterbury, since that’s where I already have connections to the EMS community. I’m lucky enough to work with two other Yale neonatologists at Waterbury Hospital, Stephanie Kyc and Ashley Cozzo, who both have a real passion for serving the community. Whichever one of us is on call at the hospital will also answer calls that come through 24/7 BABY.
Redmond: The differences between the environments — hospital versus in the field — are substantial. If we’re delivering a baby at the hospital, the amount of preparation involved is very extensive. We also have the luxury of having lots of team members.
But out in the field, there’s much less warning and many fewer people available to assist. There are so many things to do in a limited amount of time, and it feels like a less controlled setting with so many different things to potentially hone in on, so identifying in the moment what could make the most difference for the baby can be challenging.
Redmond: During the trainings we do with the EMS community, there’s an education session as well as simulation and hands-on skills training. But first responders don’t have a ton of exposure to babies in the field. Whereas, as a neonatologist, it’s a lot easier for me to retain these skills and nuanced details because I use them all the time. This is a way for us to put our expertise surrounding something that’s common for us to do every day in the hands of people for whom it’s rare day-to-day. We don’t want to come in and change the way people do things. We want to be as helpful as possible, and for 24/7 BABY to be useful, to integrate it nicely with how the EMS community already works, and to make sure we’re providing them with what they need in a way that follows the state protocols they have to adhere to.
Not every baby born outside of a hospital will need resuscitation, but because those that are are often premature, there’s a chance first responders will need to resuscitate. During those situations where they respond to deliveries without the luxury of extensive preparation, it can feel like there are many right things you could do all at once. One way a neonatologist might help is to direct focus on a key thing that helps pull everything together, such as clearing the airway or providing bag-mask ventilation. And while we may not be there physically, we can help them think about the resources they have that are helpful in the situation.
Redmond: Yes, I would love to get the program out to the rest of the state. For the first three months, we’re going to really focus the conversation on the different firehouses and EMT training facilities in the Waterbury region and adjust the program based on their feedback. Then we’d like to expand into the New Haven area and Fairfield County, and then take it statewide.
If we can positively change what happens in the first five minutes of a baby’s life, it can really make a difference for their long-term health and for the people taking care of them. I don’t know of anyone else doing something like 24/7 BABY, so we hope this can serve as a model for others. In the last couple of decades, we’ve seen a contraction in pediatric services across the country. This would be one way to help communities not as close to large neonatology centers.
Redmond: What we need most for the successful expansion of the program is for first responders to become aware of this resource and for it to integrate seamlessly into their current system. Expansion and wide adoption will require knowledge of the practices of individual units and collaboration with the regional networks of EMS services and central medical control.
With the initial launch of the program, we are relying on word of mouth and on conveying the details of how 24/7 BABY works to individuals and small groups. We hope that when first responders find it helpful, they will share their experience within their organizations and with other professionals. I anticipate much of this next year continuing to focus heavily on outreach and building trust and relationships. I would love to meet personally with as many groups of first responders as are interested in hearing about partnering in this new way.
Once we are able to make this accessible throughout Connecticut, I foresee expanding throughout New England. This program is a way of leveling the playing field for newborns, equalizing access to specialized expertise irrespective of geography, population density, and local challenges and resources.
Redmond: I was doing an EMT training session in March at the firehouse in Middlebury and told them about the new program, and everyone seemed incredibly excited about having this kind of access during these emergencies. They all programmed the number into their phones and asked if they could tell others about it.
In April, when I was at the firehouse in Beacon Falls, the EMTs described the 24/7 BABY service as a “sigh of relief.” They entered the number into their phones and took flyers to hang up and pass along to others. They said that it was reassuring to know we would be available to support them when they get called to deliveries in the community.
The first responders are going to be the professionals on the scene during these events, and they manage a remarkable breadth and depth of emergencies. Just like in everything they do, they’re invested in doing a really good job in the relatively rare instances they come across birth complications out in the field.
Redmond: Parents and caregivers should call their pediatrician if they have questions or concerns about their babies. If they are experiencing a true medical emergency with their child, they should call 911 or go to the emergency room.