Female Abdo Pain Scenario

You are working on a double-crewed ambulance (DCA) as a paramedic. You are working alongside a newly qualified member of staff who is not clinically trained (ECSW/ECA/UCS) on a night shift out of your local ambulance station which is within the geographical boundaries of England.

You are called at 0100 to a 24-year-old female reporting significant abdominal pain and vaginal bleeding. The message from control is that the patient is distressed, and the call is difficult to manage, however, there are no concerns for the crew’s safety.

On arrival you are met by the patient’s partner and are led to the bathroom. Your patient is over the toilet with a large volume of blood collected in the pan. She is visibly distressed and obtaining information is difficult. The partner explains she believes she is 8/40 gestation with her first pregnancy which was unplanned. She has decided to not progress with the pregnancy and has accessed a telemedicine abortion service to manage this.

She has taken a pill provided by this service two days ago and today took the 2nd dose as prescribed by the service. She took the first dose this evening and has been uncomfortable since with low level abdominal pain that she has been managing with over-the-counter medications. She then took a 2nd dose as prescribed at around 10pm. At midnight there was a large “gush” of PV bleeding associated with severe lower abdominal pain. This has caused significant distress and led to the patient contacting 999.