Prehospital Blood Product Transfusion by U.S. Army MEDEVAC During Combat Operations in Afghanistan: A Process Improvement Initiative

Abstract

U.S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion. These transfusions were initiated from point of injury locations aboard MEDEVAC aircraft originating from one of two locations in southern Afghanistan. All flight medics executing the transfusions were qualified through a standardized and approved program of instruction, which included day and night skills validation, and a 90% or higher written examination score. There was no adverse reaction or out-of-standard blood product temperature despite hazardous conditions and elevated cabin temperatures. All casualties within a 10-minute flight time who met clinical indications were transfused. Utilization of a standard operating procedure with strict handling and administration parameters, a rigorous training and qualification program, an elaborate cold chain system, and redundant documentation of blood product units ensured that flight medic initiated transfusions were safe and effective. Research study is needed to refine the indications for prehospital blood transfusion and to determine the effect on outcomes in severely injured trauma patients.

Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air Medical Trauma Patients

“…Both US and UK medevac platforms have implemented prehospital RBC transfusion capabilities for casualties at the point of wounding. (18, 19) Survival for these advanced platforms including prehospital RBC transfusion is greater than predicted. (35) An evaluation of advanced en-route prehospital capabilities demonstrated a 37% reduction in 30-day mortality among casualties with ISS>15.…”

Prehospital transfusion of red cell concentrates in a paramedic‐staffed helicopter emergency medical service

“…19,20 There are promising reports of military and civilian experiences in which the feasibility and potential benefits of such protocols are shown. 2,8,21 However, ideal practice and the optimal ratio of components for prehospital administration are yet to be established. 19…”

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

“…15 Military data have demonstrated that more than 90% of potentially survivable casualties die from hemorrhage and MEDEVAC platforms from the United States and the United Kingdom have PH RBC transfusion capabilities. 16–18 A recent report examining these advanced medical transport platforms demonstrated a 37% reduction in 30-day mortality for casualties with an injury severity score (ISS) of more than 15 when compared with conventional MEDEVAC platforms. 19 The authors note that 15% of patients overall received PH RBC transfusion, and among those with ISS of more than 15, a third of casualties received PH RBC transfusion.…”