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..

Greater Sydney Area HEMS podcasts


Our colleagues from Sydney have created an excellent group of podcasts about pre-hospital and retrieval medicine:

NEUROPROTECTION – covers retrieval of patients with neurological and neurosurgical emergencies; also view their helicopter operating procedure HERE

INTERHOSPITAL PATIENT ASSESSMENT – overview of the assessment of a critically ill patient requiring transfer from one facility to another

THE TRAPPED PATIENT – overview of the approach to a patient trapped in a vehicle


Analysing communication errors in an air medical transport service

The importance of effective communication

The importance of effective communication

A recent study published in the May-June 2013 edition of Air Medical Journal analyzed a randomly selected group of quality assurance reports looking for communication errors. Quality assurance reports examined had been submitted in circumstances of issues, adverse events, or simply high risk activities (for example patient requiring intubation, or scene times exceeding 20 minutes)

Of 278 reports analysed, 58 (21%) were found to involve communication errors. Communication errors were categorised according to Clark’s Communication Level Hierarchy:

Level 1: CHANNEL – establishing a means of communication between people – e.g verbal communication, digital communication

Level 2: SIGNAL – the transmitted data, for example the sound in a verbal communication or the text in a digital communication

Level 3: INTENTION – the semantic meaning derived from the content within the data

Level 4: CONVERSATION – the joint activitiy that is understood between people communication (e.g. shared mental model)

Of 65 communication errors found (from 58 reports), less than a third had been identified by staff as communication errors. Communication errors occurred most commonly at level 1 (42/64) followed by level 4 (21/64). Level 2 and 3 failures were rare.

The most common communication issue was failure to communicate change in plan or status.

The authors concluded that current quality and safety reporting systems may lack the sensitivity to identify communication errors, and that improvements to the ontology of quality and safety reporting systems, user interfaces, and staff education on reporting of communication errors could enhance the safety of air medical transport services.

Read the full article HERE (secure area limited to ADHB staff only – ADHB has subscription access to this journal via the Philson Library at the University of Auckland School of Medicine)

With thanks to Russell Clarke

“Is there a doctor on board?”

airplane 2NEJM recently published a paper looking at the outcomes of medical emergencies on commercial flights:

  • 1 in 604 flights had a medical emergency occur
  • physician passengers provided assistance in 48% of cases
  • the most common problem was syncope/pre syncope, followed by respiratory or gastrointestinal symptoms
  • few in-flight emergencies resulted in death or diversion of the aircraft

The full article, including recommendations for physicians who provide medical assistance on a commercial airliner, can be found HERE.