The Clot Module

From Dr Chris Denny, Auckland HEMS Medical Director:

Dear colleagues,
1. We need your help.
We are testing a new clinical module: The ‘Clot Module.’
Why do we want another module? To borrow an ergonomic phrase – to task cluster.
2. Please read this article (password-protected for Auckland HEMS team members only) from the 2014 Annals of Surgery; the abstract is here
3. Our early experience with prehospital blood transfusions suggest that while the mechanics of administering blood are straightforward, the cognitive stress associated with trying to perform this task, plus obtain vascular access, plus keep the patient alive, in the dark, in the rain, makes it a challenge in real life. Our vision is to cluster:
  • Two units of whole blood stored in our Credo Blood Cooler


  • Pumps sets
  • TXA
  • Belmont Buddy Lite Fluid Warmer
  • checklists, wristbands and paperwork


Early testing in Clinical Simulation Lab (AW169 mock-up)

Early testing in Clinical Simulation Lab (AW169 mock-up)

4. In the spirit of the ‘flipped classroom’, please review these three videos before or at the start of your next HEMS shift. We will then progress through a series of drills to enable our clinicians to improve their knowledge and skills in the arena of advanced circulation. Please see yourselves in the role of test pilots. It is through usability testing that lessons will be learned.
5. There are many people to thank for getting us this far:
Dr. Paul Blakemore (Auckland HEMS Fellow)
Dr. Richard Charlewood (New Zealand Blood Service)
Jonathan Davies (UK Medical Student on Resuscitation elective with Auckland HEMS)
Stefan Gabor (ARHT Clinician Educator)
Rob Gemmell (ARHT Paramedic Lead for Equipment & Ergonomics)
Dr. Alana Harper (Auckland HEMS Lead for Safety & Quality)
Dr. James Le Fevre (Auckland HEMS Lead for Strategy & Innovation)
Dr. Cameron Rosie (Auckland HEMS Lead for Operations; Equipment and Ergonomics)
Plus our colleagues at Sydney HEMS, MedSTAR and the Scottish EMRS for sharing their wisdom.
Please share your questions and suggestions with us.

Auckland HEMS prehospital blood transfusion – coming soon to a helicopter near you

Bloody hell.

Pretty much summarizes the severe traumas that define the essence of our trade.

And sometimes, the answer to critical bleeding is to give blood.

We are grateful to our colleagues at Sydney HEMS, who advise: “blood is provided to transfuse patients with life-threatening bleeding after meticulous attention to hemorrhage control.”

Auckland HEMS is poised to begin providing prehospital blood as part of our bundle of critical clinical interventions. We are fortunate to collaborate with the New Zealand Blood Service and with our local District Health Board to provide this service.

Herein, please find our training video. We welcome your feedback.

Our draft Blood SOP is undergoing usability testing with our clinical teams. Once finalized, we will share this for FOAM.

This is an unsystematic review of the current literature. A few themes are emerging:

1. There is now evidence of survival benefit in the military and in the civilian literature.
2. Beyond packed red blood cells, services are also exploring the use of plasma, and of whole blood.
3. Pouring in blood is frivolous without meticulous hemorrhage control.
4. If we are to forge strong links in the chain of trauma survival, these critically ill patients must move quickly to definitive care. We are working with our local trauma centres to move seamlessly from out of hospital into ED, Resus, Operating Theatres and Critical Care. Please share your experiences with us.
Dr Chris Denny, Auckland HEMS Medical Director
(Auckland HEMS team members click HERE for access to the draft SOP)


Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study

Initial UK experience of prehospital blood transfusion in combat casualties

The effects of prehospital plasma on patients with injury: a prehospital plasma resuscitation

The feasibility of civilian prehospital trauma teams carrying and administering packed red blood cells

Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients

Emergency whole-blood use in the field: a simplified protocol for collection and transfusion

Blood Far Forward–a whole blood research and training program for austere environments

Australian Patient Blood Management Guidelines


…and for simulation purposes, here is a blunt force trauma scenario:

An unidentified surfer discovers the hazards of being caught inside at a notoriously shallow reefbreak during the biggest swell in two years..