{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:40:50Z","timestamp":1792654850422,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007747","name":"University of Utah","doi-asserted-by":"publisher","award":["1U4U"],"award-info":[{"award-number":["1U4U"]}],"id":[{"id":"10.13039\/100007747","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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\u2010based interprofessional quality improvement initiative was designed and implemented to expand state EMS protocol guidelines to address the timing, route and administrator of oxytocin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Process<\/jats:title>\n                    <jats:p>Using stepwise processes from Powell's Expert Recommendations for Implementing Change implementation science taxonomy, we combined bottom\u2010up and top\u2010down strategies, including stakeholder and decision\u2010maker interviews, community\u2010level focus groups, partner surveys, and coalition building to foster change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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\u2010based birth, and obstetric\u2010care 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jmwh.70194","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:15:37Z","timestamp":1792653337000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Community Partnership Initiative in Utah to Enhance Prehospital Perinatal Care in the Prevention of Postpartum Hemorrhage"],"prefix":"10.1111","author":[{"given":"Joshua","family":"Larson","sequence":"first","affiliation":[{"name":"College of Health University of Utah  Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer E.","family":"Kaiser","sequence":"additional","affiliation":[{"name":"OBGYN Department ASCENT Center University of Utah  Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caren J.","family":"Frost","sequence":"additional","affiliation":[{"name":"College of Social Work University of Utah  Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"OBGYN Department LIFT Simulation Lab ASCENT Center University of Utah  Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010025\u201002988\u2010z"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002351"},{"key":"e_1_2_9_4_1","unstructured":"March of Dimes.2023 Maternal Mortality Report Card: United States.2023. Accessed January 11 2026.https:\/\/www.marchofdimes.org\/sites\/default\/files\/2023\u201011\/MarchofDimesReportCard\u2010UnitedStates.pdf"},{"key":"e_1_2_9_5_1","volume-title":"Nowhere to go: maternity care deserts across the US","author":"Stonburner Ashley","year":"2024"},{"key":"e_1_2_9_6_1","unstructured":"World Health Organization.WHO Recommendations: Uterotonics for the Prevention of Postpartum Haemorrhage. December 20 2018. Accessed July 13 2026.https:\/\/www.who.int\/publications\/i\/item\/9789241550420"},{"issue":"11","key":"e_1_2_9_7_1","first-page":"656","article-title":"Oxytocin as first\u2010line uterotonic therapy for postpartum hemorrhage","volume":"103","author":"Ford B","year":"2021","journal-title":"Am Fam Physician"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.65096"},{"key":"e_1_2_9_9_1","volume-title":"Emergency Medical Transportation: A Review of Accountability and Rate Setting","author":"Office of the Legislative Auditor General","year":"2024"},{"key":"e_1_2_9_10_1","unstructured":"National Association of State EMS Officials.National emergency medical services assessment. Published online 2020. Accessed July 13 2026.https:\/\/www.ems.gov\/resources\/newsletters\/september-2020\/national-ems-assessment-describes-current-state-of-ems-in-theunited-states\/"},{"key":"e_1_2_9_11_1","unstructured":"Weber State University Department of Emergency Healthcare.Degrees and programs.2026.Weber State University website. Accessed July 13 2026.https:\/\/www.weber.edu\/eh\/degreesprograms.html"},{"key":"e_1_2_9_12_1","unstructured":"EMT Utah.Advanced EMT.2026. Accessed July 13 2026.https:\/\/www.emtutah.com\/ch_courses\/advanced\u2010emergency\u2010medical\u2010technician\/"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2023.2283892"},{"key":"e_1_2_9_14_1","unstructured":"V3 state procedures medications and protocols.National Emergency Medical Services Information System (NEMSIS) website. Published online 2023. Accessed July 13 2026.https:\/\/nemsis.org\/view\u2010reports\/state\u2010reports\/version\u20103\u2010state\u2010dashboards\/v3\u2010state\u2010procedures\u2010medications\u2010and\u2010protocols\/"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1380094"},{"key":"e_1_2_9_16_1","unstructured":"Medical direction & EMS protocol guidelines.Utah Department of Public Safety Bureau of Emergency Medical Services website. Published online September 2025. Accessed July 13 2026.https:\/\/ems.utah.gov\/operations\u2010and\u2010response\/medical\u2010directionems\u2010protocol\u2010guidelines\/"},{"key":"e_1_2_9_17_1","unstructured":"BaaydJ LloydM GarciaG CohenS.Using simulation training to improve the quality of emergency birth transfers in Utah.Presented at: Utah Public Health Association Conference; May 14 2021;Salt Lake City Utah."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012\u2010015\u20100209\u20101"},{"key":"e_1_2_9_19_1","unstructured":"HeroJO GoodrichDE ErnecoffNC et\u00a0al.Implementation Strategies for Evidence\u2010Based Practice in Health and Health Care: A Review of the Evidence. Patient\u2010Centered Outcomes Research Institute;2023. Accessed November 1 2024.https:\/\/www.pcori.org\/sites\/default\/files\/PCORI\u2010Implementation\u2010Strategies\u2010for\u2010Evidence\u2010Based\u2010Practice\u2010in\u2010Health\u2010and\u2010Health\u2010Care\u2010A\u2010Review\u2010of\u2010the\u2010Evidence\u2010Full\u2010Report.pdf"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102015\u2010004411"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.54531\/seny1267"},{"issue":"35","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"762","DOI":"10.15585\/mmwr.mm6835a3","article-title":"Racial\/ethnic disparities in pregnancy\u2010related deaths \u2010 United States, 2007\u20102016","volume":"68","author":"Petersen EE","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_9_23_1","unstructured":"Women in the US more likely to die in pregnancy childbirth and postpartum than women in other high\u2010income nations. The Commonwealth Fund website. November 18 2020. Accessed January 15 2026.https:\/\/www.commonwealthfund.org\/press\u2010release\/2020\/women\u2010us\u2010more\u2010likely\u2010die\u2010pregnancy\u2010childbirth\u2010and\u2010postpartum\u2010women\u2010other\u2010high"},{"key":"e_1_2_9_24_1","unstructured":"Paramedic protocol provider. ACIDREMAP website. 2022.https:\/\/acidremap.com\/"},{"key":"e_1_2_9_25_1","unstructured":"NASEMSO.National Model EMS Clinical Guidelines version 3.0. March 2022. 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