Civilian emergency medical services utilize prehospital blood products in Great Britain, Australia, Norway, the Netherlands, Sweden, Finland, and more. The collective conclusion from reports from these countries is that it is feasible and safe to deliver pre-hospital transfusions. Depending on the surrounding population, 1–8 patients per month are in need of prehospital transfusion by a HEMS unit. Read more about the experience from the first Finnish HEMS unit that carried red blood cells on EMS missions in Finland.
Prehospital administration of blood products: experiences from a Finnish physician-staffed helicopter emergency medical service
Background
Massive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome. Military experience suggests avoiding crystalloids using early damage control resuscitation with blood components in out-of-hospital settings. Civilian emergency medical services have since followed this idea. We describe our red blood cell protocol in helicopter emergency medical services (HEMS) and initial experience with prehospital blood products from the first 3 years after implementation.
Methods
We performed an observational study of patients attended by the HEMS unit between 2015 and 2018 to whom packed red blood cells, freeze-dried plasma, or both were transfused. The Student’s two-sided T-test was used to compare vitals in the prehospital phase with those at the hospital’s emergency department. A p-value < 0.05 was considered significant.
Results
Altogether, 62 patients received prehospital transfusions. Of those, 48 (77%) were trauma patients and most (n = 39, 81%) suffered blunt trauma. The transfusion began at a median of 33 (IQR 21–47) minutes before hospital arrival. Median systolic blood pressure showed an increase from 90 mmHg (IQR 75–111 mmHg) to 107 mmHg (IQR 80–124 mmHg; P < 0.026) during the prehospital phase. Four units of red blood cells were handled incorrectly when unused red blood cells were returned and required disposal during a three-year period. There were no reported adverse effects from prehospital transfusions.
Conclusion
We treated two patients per month with prehospital blood products. A prehospital physician-staffed HEMS unit carrying blood products is a feasible and safe method to start transfusion roughly 30 min before arrival to the hospital.
The ˚M Warmer System
The ˚M Warmer is a portable blood and IV fluid warming device optimal for both prehospital and hospital use as it is small, simple to use and has extremely efficient warming capabilities (150 ml/min).