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

Thomas.Ellison at hcahealthcare.com Thomas.Ellison at hcahealthcare.com
Fri Apr 6 22:48:10 BST 2012


Having worked in both the USA and the UK I am very aware of the opportunities advanced trained EMS crew bring to the care trauma patient in sometimes very austere environments,  interestingly in the UK HEMS at the Royal London flies with a Doctor while in the USA this is not always the case where it is more common to find a paramedic or nurse paramedic team.  I believe the Mayo clinic conducted research on the feasibility of having blood on board  and those findings were published in 1998 in the Air Medical Journal, presented at several conferences in Europe in addition to the U.S.I can think of only a few pre hospital teams carrying blood and perhaps fewer carrying blood and plasma, Interestingly Sumida et all published research in Air Med J. 2000 Oct-Dec;19(4):140-3. Prehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients. And came to the conclusion  "Patients with lengthy flight times, despite the administration of blood products, presented to the trauma center more acidotic than trauma patients receiving only crystalloid. The true impact of blood products on outcome could not be demonstrated because of statistical differences in flight times between the groups. A multicenter study matching flight times, head injury status, and flight type of assess benefit of pre hospital utilization of blood products is warranted"
I look forward to the very excellent trauma team at the Royal London publishing their data and findings in the future, and would ask also ask for pre hospital teams who carry blood and plasma share their protocols with this group 
Respectfully 

Thomas Ellison RN
VP,  Trauma, Acute Care Surgery and Surgical Critical Care 
Lawnwood Regional Medical Center 
1700 S 23rd Street 
Fort Pierce Florida 34950
USF HCA Trauma Network 







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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Stephen Richey
Sent: Friday, April 06, 2012 5:13 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Giving packed red blood cells in the prehospital phase of care... a good idea?

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
> > > --
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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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> >
>
>
> --
> Sent from Gmail Mobile
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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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