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Blood on Helicopter


butlermom
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We are being asked to supply blood for a helicopter. My question is, how do we properly account for the unit(s) if a patient is picked up from an accident scene, transfused in flight, but taken to another hospital? The patient would never be registered at our facility so would we then make a “transfer” of the unit(s) to the receiving hospital? I’m just trying to figure out how to keep track of the blood since it’s from our inventory.

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My lab is also partnering with a transport transfusion service and I've wondered the same thing.

  1. Perhaps you'd need to register the pt regardless just to document the use of units or,
  2. The chopper should only have blood on it from the particular hospital that it would transfer pts. or,
  3. Operate like you suggest and make transfers to that service (however, how do you document proper transfer physically?)

I would say if you're transfusing in the chopper (sort of a middle ground, under the jurisdiction of your hospital), you need to document that a pt was transfused under your control, just at a satellite location. The pt being moved after transfusion to another facility doesn't mean Facility #2 has to deal with the units/transfusion... does that make a sort of sense for sake of discussion? :giggle:

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Agree with the comment above.  While the patient is in your chopper with your blood, it's your patient.  Somehow you must be be charging for the ride and any other care in flight.  And like any unit transferred with a patient to another facility, you will have to follow up to finish the transfusion record.

Scott

 

 

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We supply blood to 5 helicopters around this area.  If blood is given in flight or if the units are wasted because they are out of temperature for any reason, the charge is passed on to the helicopter service.  We document that the unit was given to a patient and then we change the status of the unit to a Final Status in the computer.  Apparently, the helicopter service charges a flat rate to the patient no matter what is used, so the charge for the blood is just part of that service.

Anne

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I will add some info here to clarify our situation further:  We do not have a helicopter. It is a local company that wants us to provide the blood to them and administration wants us to do this. If our blood is on the chopper but they pick up a patient and take him/her to another hospital, the patient would not be registered here and there would be no record of us giving the blood. Possibly we could have documentation from the helicopter personnel with patient info and the unit they gave and we could have some sort of quick-registration process on our side so we could at least show the patient received the blood in an emergency situation. I guess asking the crew to bring a sample back to us would be asking too much, huh?!

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We supply blood to a helicopter service with a contract with our hospital system.  We put Safe-T-Vue indicators on all of their units.  They provide us a copy of their in-flight chart when they transfuse anyone not coming to our hospitals.  If the patient doesn't come to us but has an account in our HIS, we create a bogus registration in our BBIS using a defined format account number.  If they don't exist in our HIS, we create a complete registration manually in our BBIS using a defined format for MR# etc.  Then we emergency issue the product in our BBIS and handle it just as we would those patients who expire before a specimen is drawn etc.  We charge the helicopter service for the products which they include in their flat fee to the patient.  We maintain the final disposition records for any lookbacks etc.  If we got a market withdrawal or lookback, we would notify the helicopter company to follow up with the recipient.  That duty is at least vaguely covered in our agreement with them, I believe.  We tell the helicopter crew to return any unused products to us and not to leave them at the receiving hospital but this isn't perfect.  We sometimes transfer products on paper to the receiving site if we can document handling sufficiently. It doesn't work easily if the receiving hospital doesn't use the same blood supplier.

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On 9/18/2019 at 3:17 PM, Mabel Adams said:

We supply blood to a helicopter service with a contract with our hospital system.  We put Safe-T-Vue indicators on all of their units.  They provide us a copy of their in-flight chart when they transfuse anyone not coming to our hospitals.  If the patient doesn't come to us but has an account in our HIS, we create a bogus registration in our BBIS using a defined format account number.  If they don't exist in our HIS, we create a complete registration manually in our BBIS using a defined format for MR# etc.  Then we emergency issue the product in our BBIS and handle it just as we would those patients who expire before a specimen is drawn etc.  We charge the helicopter service for the products which they include in their flat fee to the patient.  We maintain the final disposition records for any lookbacks etc.  If we got a market withdrawal or lookback, we would notify the helicopter company to follow up with the recipient.  That duty is at least vaguely covered in our agreement with them, I believe.  We tell the helicopter crew to return any unused products to us and not to leave them at the receiving hospital but this isn't perfect.  We sometimes transfer products on paper to the receiving site if we can document handling sufficiently. It doesn't work easily if the receiving hospital doesn't use the same blood supplier.

Appreciate this information Mabel. We are not currently providing blood for our contracted air service except for transfers for our patients, but I can see the day coming where this might change. What you've described would work very well for us I think.

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  • 1 month later...

At the recent AABB meeting San Antonio reported on their program with whole blood out on ambulances and helicopters.  When the blood bags come in with the patient to their ED, they are sent to BB so they can be crossmatched after the fact.  Here, we keep segments from the units that we provide to our medical transport partner so we can crossmatch those brought to our facility if serological XM is needed or if a reaction occurs.  In TX they have two level 1 trauma centers and I think more than one supplier for the units so they have to try to solve it at the receiving site.

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  • 1 year later...

Can anyone share their logistics to storing blood at the launch pads for the choppers?  We are getting a requests to store whole blood at each chopper launch site so the flight team can grab a cooler and take it with them out to the field.  I am wondering about storage, coolers, freezing of ice packs for the coolers, swapping out the shortdated WB, documentation of storage temps, documentation of transfusion etc.  Has anyone else already figured these pieces out? Love to see a policy or procedure for this...Thanks!

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19 hours ago, RKB1988 said:

Can anyone share their logistics to storing blood at the launch pads for the choppers?  We are getting a requests to store whole blood at each chopper launch site so the flight team can grab a cooler and take it with them out to the field.  I am wondering about storage, coolers, freezing of ice packs for the coolers, swapping out the shortdated WB, documentation of storage temps, documentation of transfusion etc.  Has anyone else already figured these pieces out? Love to see a policy or procedure for this...Thanks!

That sounds like an absolute logistical nightmare. Maybe I have missed something but I have visions of coolers being left in the helicopter, on the helipad (winter and summer), in bathrooms and forgotten in corridors etc.  

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On 10/25/2019 at 12:32 PM, Mabel Adams said:

At the recent AABB meeting San Antonio reported on their program with whole blood out on ambulances and helicopters.  When the blood bags come in with the patient to their ED, they are sent to BB so they can be crossmatched after the fact.  Here, we keep segments from the units that we provide to our medical transport partner so we can crossmatch those brought to our facility if serological XM is needed or if a reaction occurs.  In TX they have two level 1 trauma centers and I think more than one supplier for the units so they have to try to solve it at the receiving site.

I work in a San Antonio hospital and what was reported at AABB was the expectation. It is NOT the reality. 

First, all units supplied to the ambulances and helicopters come from our regional donor center. No hospital transfusion service provides the units nor are we responsible for the disposition of the same. All of this is monitored and tracked by the regional donor center and the EMS.

What is supposed to happen is, when a patient has been transfused en route, the completed unit and EMS's transfusion form is supposed to be sent to the blood bank upon arrival. This almost never happens. The only way we know in the blood bank is when we get mixed field reactions on our blood type or by reading physician notes on the chart. I read the physician note of every emergency release. That is how I normally find them. The physician will dictate that the patient received blood in the ambulance. It takes days for me to track down the paperwork and the empty bag is long gone by then. We NEVER crossmatch them because we never receive them. 

All that said to say, your helicopter company needs to contract with whomever your blood supplier is to stock the units. That should not come from the transfusion services department of the local hospital. You might serve as a pass-through site, meaning the donor center uses you as a pick-up point but the units are never part of your inventory.

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4 hours ago, Ensis01 said:

That sounds like an absolute logistical nightmare. Maybe I have missed something but I have visions of coolers being left in the helicopter, on the helipad (winter and summer), in bathrooms and forgotten in corridors etc.  

That's exactly why I am asking if someone figured this out and has a reliable workflow.  I can't imagine the proposed process actually working.

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I can describe how it works for our healthcare system and PM a copy of our policy.  The pre-hospital transfusions on the helicopter pre-dated me at this facility but I have expanded to ambulance pre-hospital transfusions on 3 ambulances with begging to increase to 4 ASAP.

We maintain sets of 2 O NEG RBC and 2 low-titer liquid Group A plasmas for 1 helicopter and 2 ambulances that work out of the level 1 trauma center. We set up a dummy patient for each vehicle and units are pre-labeled for that dummy patient, segments are retained at the Blood Bank, each unit wears a Saf-T-Vue10 indicator and a triplicate Emergency Release form with unit numbers documented on the form with one copy of the form retained in the Blood Bank to keep track.  Each vehicle uses the Pelican Biothermal Credo and changes out each blood product set once every 24 hours.  The crew at the vehicle base is responsible for exchanging the cold panels for the credo.  Each credo carries a datalogger and the datalogger report is downloaded and emailed to the Blood Bank at least weekly for review.  Each credo is validated to maintain temperatures for up to 3 days prior to being released for active use.  When a patient is transfused, the flight/medic crew is responsible for returning one of the copies of the emergency release form signed by the crew's MD to the originating Blood Bank and one copy goes on the patient's chart. Units are released from the dummy patient, crossmatched (if we get a sample), and transfused in the LIS to the actual patient.  The crew returns to their base to replenish the units that were transfused.

If the patient is transferred to a hospital that isn't part of our healthcare system, we still have a copy of the form returned to us and the crew will tell us where the patient was transported to and we "transfuse" the dummy patient with unit comments in the LIS with whatever information we received from the crew .

 

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We were the first to provide helicopter blood in MA.  It was a long process, but we've simplified it as much as possible.

Our primary supplier in MA is ARC.  They would not perform the ABO / Rh retype for Boston MedFlight (BMF).  The products come to us.  We went with O Pos RBCs.  We have our own donor center but are not licensed, so chose to get them irradiated from ARC as they will travel outside of the state.  That was OK for a couple of years, then we started adding bases and liquid plasma.  We contacted FDA and learned we were allowed to irradiate the plasma, so they now have that too.

We worked very closely with BMF in setting up their program, they were the greatest bunch of people to work with.  They have a blood bank fridge and freezer at each base and are using Credo coolers.  We worked with them to perform validations on the products stored on the ground and air ambulances.  All coolers maintain temp far past 12 hours.  They swap out the coolers every 12 hours.  We were concerned this might be considered storage more than transport, so they now monitor all coolers 24/7.  They have Wi-Fi on the helicopters.  They return the RBCs if they get too close to their outdate.  The plasma we do not want back as we do not use this product in our hospital.  They sell it to a fractionator.

We've been inspected by TJC since we've gone live, and the survey went fine.  We had a virtual inspection with FDA in July, no comment as of yet.  AABB chose not to go out to any of the bases.

They have transfused a lot of products making this a very successful program.

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Hi John,

We bill them for the products.  If the RBCs are retuned, there is 0 charge.  No charge for any service or processing on our end.

As I mentioned, we bill for all liquid plasma as it's not a product we transfuse in the hospital, and we don't want it returned to reduce the chance we use it in error.

They bill for the transfusion.

BMF is an unusual setup, they are a consortium funded nonprofit.  We're one of the hospitals that funds them.

Thanks

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