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Giving packed red blood cells in the prehospital phase of care... a good idea?

Stephen Richey stephen.richey at gmail.com
Fri Apr 6 22:13:25 BST 2012


The delay is inherent in HEMS operations because of the flight aspects and
not the medical aspects necessarily.  8 or 9 out of 10, the ground
ambulance in most areas will beat the helicopter back to the hospital
assuming that ground crew isn't dicking around on scene.

On Fri, Apr 6, 2012 at 5:10 PM, Bryan Boling <bryanboling at gmail.com> wrote:

> When I worked at the university and they operated ER own HEMS service, we
> used to carry a cooler with a few units of O neg on the aircraft. I don't
> know the policies exactly, but that was staffed by a nurse and medic with
> direct contact with a medical director in the ED via radio. I believe the
> transfusions were only used during extended transport from a scene (we
> covered a large rural area). To my knowledge, transport was never delayed
> due to transfusion. They don't run their own service anymore but contract
> it out (got too expensive) so I don't know if the new group does the same.
> Bryan
>
> On Friday, April 6, 2012, Stephen Richey wrote:
>
> > For the most part, I would say no at least here in the US since the
> average
> > level of education for a paramedic leaves much to be desired (speaking
> as a
> > former EMS educator myself).  The issues with quality control, supply
> > maintenance, the need to determine clinical need (EMS providers tend to
> > massive over-estimate the severity of patients' conditions because most
> of
> > them are taught "cookbook" defensive medicine) and cost.  I am not sure
> how
> > the blood banking situation is in other countries but here there are
> often
> > region-wide shortages of blood products so the sequestration of a
> > significant amount in the hands of EMS providers would probably only
> > exacerbate the situation.
> >
> > Also, the problem is worsened by the fact that the patients who would
> > probably benefit most from field transfusions are the ones in the areas
> > least suited to its use because of administration, training and supply
> > issues.  Rural EMS tends to be almost all volunteer and many of these
> folks
> > never even meet their medical director let along receive any meaningful
> > QA/QI feedback.  The idea of giving the blood to the local HEMS operators
> > and using them to deliver a higher level of care isn't going to work
> > because you're going to delay the arrival of the patient in the OR in all
> > but the most remote of areas.
> >
> > In urban settings, you're not going to have that much need for
> transfusion
> > because of the proximity to trauma centers.  Here for example, it's
> > abnormal for EMS providers (such as my fiancee) to take longer than 20
> > minutes from call to arrival at the hospital.
> >
> > On Fri, Apr 6, 2012 at 3:12 PM, Karim Brohi <karim at trauma.org
> <javascript:;>>
> > wrote:
> >
> > > So our trauma helicopter emergency medical service recently started
> > > carrying packed cells:
> > > http://www.bbc.co.uk/news/health-17232529
> > >
> > > We'll obviously be auditing its use closely, but I'm interested in
> > > garnering the lists opinions on this:
> > > Who should get PRBCs?
> > > Should anyone get PRBCs?
> > > Why aren't we carrying plasma as well?
> > >
> > > There are a couple of prehospital services in the US carrying blood
> > > and plasma to my knowledge, and it is used by MERT teams in combat
> > > zones.
> > >
> > > So??
> > >
> > > Karim
> > > --
> > > trauma-list : TRAUMA.ORG
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> > >
> >
> >
> >
> > --
> > Stephen Richey
> > Founder and Chief Researcher/Designer
> > Kolibri Aviation Safety Research
> > 5174-B Winterberry Circle
> > Indianapolis, IN 46254
> > 317-985-4740
> >
> >  "I think the best thing, and the only thing in our infinite inadequacy
> in
> > making up for the loss of life, is to say something we have been able to
> > say in a lot of other accidents to grieving families.  That is 'Those
> > deaths will not be in vain. We will not let them be in vain. Every one of
> > those lives will be made to count in terms of making sure that three,
> four,
> > five or ten other people do not die."- John J. Nance
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
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-- 
Stephen Richey
Founder and Chief Researcher/Designer
Kolibri Aviation Safety Research
5174-B Winterberry Circle
Indianapolis, IN 46254
317-985-4740

 "I think the best thing, and the only thing in our infinite inadequacy in
making up for the loss of life, is to say something we have been able to
say in a lot of other accidents to grieving families.  That is 'Those
deaths will not be in vain. We will not let them be in vain. Every one of
those lives will be made to count in terms of making sure that three, four,
five or ten other people do not die."- John J. Nance


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