Roe V. Wade and What This Means for EMS Providers
Right off the rip, I'm not a lawyer, so please do not use anything I say as legal advice.
In case anyone missed it, the Supreme court of the United States ruled to overturn Roe V. Wade, deeming it unconstitutional. While Roe V. Wade guaranteed a variety of freedoms I do not possess the intelligence to speak about we'll focus on the issue of abortion. I would say that this post is not meant to be political but honestly, I'm not sure if there's a way to separate politics from any discussion on abortion (not to mention that politics and medicine are intertwined regardless of the Roe V. Wade decision.) So what I am going to attempt in this blog post is to discuss how I believe Roe V. Wade will impact pre-hospital health care workers nationwide.
What Even is Roe V. Wade?
I'm glad you asked! According to Google and some Wikipedia articles, Roe V. Wade was a landmark Supreme court case that guaranteed certain freedoms, specifically the right to abortion and of particular interest, a right to privacy. Shocker, but this decision created some serious blowback from anti and pro-abortion rights activists. Anti-abortion activists thought that there should be no right to abortion, while pro-abortion rights activists thought that Roe V. Wade did not go far enough to protect the right to abortion.
Again, I'm not a legal expert and the above was researched using the good ole' fashioned Google. Cliff notes for Roe V. Wade should include that abortion was specifically outlined as a constitutional right in this ruling, and that people were very upset about this.
So How Does This Effect Providers?
Now it's time to talk about things I know slightly more about. Providers in both Red and Blue states will see an uptick in pregnancy related calls. Ectopic pregnancies are one such example of calls we will see more of. Here's a through back to that OBGYN chapter in your EMT text book. An ectopic pregnancy is the result of egg fertilization outside of the uterus. These locations include the abdominal cavity or ovary, but more often than not occurs within the fallopian tube. With appropriate treatment, these pregnancies can be managed and result in a healthy outcome for the mother. Without appropriate treatment, these pregnancies can cause massive internal hemorrhage that can result in shock and eventually death. The appropriate treatment for an ectopic pregnancy is to abort the pregnancy. If abortion is not an option then surgical intervention is required.
From an EMS perspective we don't have many options to treat these patients in the field. We can treat for shock and hope like hell the patient doesn't crash while en route to the hospital. Not a great position to be in. As someone who has been in this position with a 16 year old patient, I can personally attest to how horrible of a situation this is to be in.
Moving on from the lovely discussion of ectopic pregnancy we can now discuss illegal and botched abortion attempts. Make no mistake, outlawing abortion does not mean abortions will not be attempted. If anything it means that in certain states there is now no safe way for this procedure to take place. Patients may try to hide the fact that they were attempting an abortion, hiding potentially important medical information from providers. This is not exactly a great place to be in as a provider. When it comes to treatment ensure you have solid assesment skills. The cause of an injury of illness may not be apparent, therefore assesment skills will become incredibly important. As always, treat for shock and get the patient to definitive care.
This part is purely speculative but I believe certain states will see the emergence of a abortion pharmacological black market. States where abortion is legal will attempt to ship medications to those attempting abortions in states where the procedure is illegal. This weird illegal pharmaceuticals trade could potentially spell disaster for certain patients. These medications will not be dosed appropriately and EMS providers will be left to deal with the fallout.
Final Thoughts
In conclusion, this is gonna be a bit of a mess. I'm hopeful that some guidance will be released by the CDC or WHO on how to effectively treat the influx in pre-hospital pregnancy related emergencies we will encounter. Ultimatley I'm nervous for EMS providers nation wide who will deal with the immediate consequences of the Supreme court's decision. I think we can all agree that the back of an ambulance is the last place anyone wants to experience a pregnancy related medical emergency.