Prepared for the Unthinkable: How VHSO ED Staff Are Rising to the Challenge of Obstetric Emergencies

Whether it’s a cardiac arrest, a traumatic injury, or a mental health crisis, the Emergency Department (ED) stands ready 24/7. But what happens when the emergency is something rare, time-critical and involves two lives at once?

This is the story of how VHSO’s ED providers are preparing for the unexpected—with courage, commitment and cutting-edge training to handle obstetric emergencies.

An Emergency Like No Other

Picture this: a woman walks into the Veterans Health Care System of the Ozarks Emergency Department late at night. She’s holding her belly, breathing hard and tells the nurse her contractions started an hour ago. Less than three hours later, she’s holding a newborn.

This may sound like something out of a movie, but it’s a very real possibility—even in a VA hospital that doesn’t deliver babies.

Obstetric emergencies—such as maternal hypertensive crisis, precipitous delivery and postpartum hemorrhage—can happen without warning, often in patients who never expected to be in a VA emergency room. And while maternal cases are uncommon at VHSO, preparedness can make all the difference.

High-Risk, Low-Frequency, Life-or-Death

Arkansas leads the nation in maternal mortality rates. Many counties no longer have functioning birthing hospitals. And while the VA does not house an OB unit, pregnant and postpartum patients could still arrive—seeking urgent care, sometimes unaware that their symptoms are related to recent childbirth.

This reality led VHSO to act.

In partnership with the Arkansas Perinatal Quality Collaborative, VHSO launched a comprehensive OB Emergency Training program. It’s designed not just to improve clinical readiness, but to save lives in the precious first moments of maternal crisis.

Training to Save Two Lives at Once

The program focuses on three critical emergency categories:

1. Maternal Hypertensive Crisis
   Recognizing preeclampsia, eclampsia and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome
   Administering lifesaving medications like magnesium sulfate and labetalol
   Monitoring central nervous system symptoms like headaches, clonus or vision changes
2. Precipitous Delivery
   Identifying labor—even silent or fast-onset cases
   Safely assisting in emergency births
   Performing neonatal assessments and basic resuscitation steps
3. Maternal Hemorrhage
   Estimating blood loss and activating massive transfusion protocols
   Administering uterotonics (e.g., oxytocin, TXA)
   Coordinating rapid postpartum interventions and documenting accurately

How It Was Taught: Simulation, Scenarios and Teamwork

VHSO’s training includes:

• Hands-on simulations with lifelike OB scenarios
• Clinical checklists and emergency algorithms
• Team-based drills involving pharmacy, nursing, providers and ancillary staff
• Skill stations for neonatal resuscitation, hemorrhage control and medication administration

“This training is a game-changer,” said Latham Thigpen, ED RN. “It helped us build muscle memory, develop a shared language and respond as a unit. Now, we’re ready.”

Real-Life Impact—Right Away

Just one shift after the training, Toni Hess, ED RN, triaged a patient who was three months postpartum. Her blood pressure was elevated, but there were no overt OB symptoms. Before this training, her hypertension might have been missed or under-triaged. Instead, Toni recognized the risk of postpartum preeclampsia and ensured proper follow-up care.

“We were able to intervene early, provide the right education, and possibly prevent a major complication down the line,” she said.

Why This Matters at the VA

Despite not being a labor and delivery hospital, VHSO’s ED is often the first point of contact for many patients in crisis, including spouses and non-enrolled walk-ins. Being prepared for obstetric emergencies is essential for:

• Patient safety – Early recognition of hypertensive disorders or hemorrhage can prevent seizures, strokes and death.
• Team confidence – Simulation builds shared mental models, improving performance in high-stress moments.
• Continuity of care – Accurate documentation, communication and appropriate disposition ensure safe transitions to OB/GYN services.

“We’re not just preparing for emergencies,” one nurse said. “We’re preparing to save lives—two at a time.”

What’s Next

The success of this program is only the beginning. VHSO is:

• Incorporating OB emergency training into annual continuing education
• Developing quick-reference OB guides for ED providers and nurses
• Exploring the use of OB emergency kits in critical care areas
• Continuing partnerships with state-wide maternal health initiatives

A Culture of Readiness and Respect

VHSO treats every patient with whole-person, trauma-informed care—whether they’re a Veteran, a spouse or a member of the community in need. When the unexpected happens—when a life (or two) hangs in the balance—the ED team is trained, equipped and ready.

Because excellence in emergency care isn’t just about skill, it’s about commitment to those we serve, no matter what the circumstance.

At VHSO, readiness is a promise we keep.