Lesson
Vaginal Bleeding in the Field
Objective: Ask pregnancy, treat shock, and know the two scenes that kill: ectopic and postpartum hemorrhage.
Why This Is Hard
They say it is a heavy period. BP is 78. ACOG and NAEMSP: suspected ectopic and postpartum hemorrhage are time-critical. You will not speculum on the truck.
On this truck
- Pregnancy in anyone who can be pregnant.
- External pads, not packing the vagina.
- Postpartum: feel the fundus if trained — atony is a massage and protocol-med problem (oxytocin if you carry it).
Field Rules (Education)
- Ectopic theme: pelvic pain, bleeding (can be light), syncope, shock. Shoulder pain. Known IUD or prior ectopic raises risk.
- Miscarriage can still bleed enough to shock. Treat shock.
- Postpartum: within 24 hours is primary PPH teaching. Fundal massage, oxytocin if protocol, pelvic binder is not a uterus. Destination OB-capable.
- Do not pack the vagina. External control, two large-bore IVs per shock protocol, keep them warm.
Field Pitfalls
- “Heavy period” refusal in a hypotensive 28-year-old.
- Packing the vagina.
- Forgetting fundal massage in atony.
Practice
60-second drill
Partner: (1) syncope, missed period, BP 80; (2) delivered at home 2 hours ago, soaking pads, boggy uterus. First actions.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACOG postpartum hemorrhage — atony, massage, uterotonics — protocol owns the drug
- ACOG — ectopic pregnancy is a surgical emergency — field job is shock and destination
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.