Can Bimanual Compression be Delegated?

External bimanual compression is not a delegated medical act. The preferred provider is the paramedic because they have the specific training to locate the uterine fundus, apply the correct directional force, and assess whether the maneuver is improving uterine tone and controlling hemorrhage. 

However, because the maneuver itself does not fall under a controlled or restricted act, it can be delegated to allied responders when circumstances require it. Situations such as provider fatigue, extremely limited resources, or the need for the paramedic to manage airway, intravenous access, or rapid transport planning may justify having a trained responder maintain external compression under direct instruction. In these cases the paramedic remains responsible for initial placement, confirmation that the technique is effective, and intermittent reassessment.

The guiding principle is that the paramedic performs the maneuver when possible, but delegation is acceptable and safe when done with clear direction and oversight.