Air Ambulance Transfusion

[OkayestSBB]

Hi All, I'm curious if anyone knows or can point me in the right direction regarding air ambulances and the responsibilities associated when units are transfused in-flight.    Do those units need to be retroactively crossmatched by the facility receiving the patient? Or is there an exemption of some sort in these scenarios?  Any info, documentation standards etc is greatly appreciated! 

[jayinsat]

As far as I have been able to ascertain, unless your facility provides the units to the air ambulance, you have no responsibility for their crossmatching or transfusion. Those records should be kept by the donor services that provide them. Our ambulances and helicopters carry low titer O pos whole blood provided by our local blood supplier. When they are given en route, the EMS is supposed to give the record of transfusion to the Emergency Department staff, and that staff is supposed to forward one copy of it to us in the blood bank, along with the bag, so we know the patient received the unit (as it may interfere with blood typing). That, however, rarely happens. It is not until we have an ABO discrepancy (mixed field in the front group) that we begin to realize what happened. 

For your responsibility, it is the same as if a patient were given uncrossmatched blood at a remote hospital and then transferred to your hospital. The responsibility of the crossmatch and transfusion is on the prior facility.

[OkayestSBB]

1 hour ago, jayinsat said:

As far as I have been able to ascertain, unless your facility provides the units to the air ambulance, you have no responsibility for their crossmatching or transfusion. Those records should be kept by the donor services that provide them. Our ambulances and helicopters carry low titer O pos whole blood provided by our local blood supplier. When they are given en route, the EMS is supposed to give the record of transfusion to the Emergency Department staff, and that staff is supposed to forward one copy of it to us in the blood bank, along with the bag, so we know the patient received the unit (as it may interfere with blood typing). That, however, rarely happens. It is not until we have an ABO discrepancy (mixed field in the front group) that we begin to realize what happened. 

For your responsibility, it is the same as if a patient were given uncrossmatched blood at a remote hospital and then transferred to your hospital. The responsibility of the crossmatch and transfusion is on the prior facility.

We do provide the units to the air ambulance.  Patients transfused with those units can either get transferred to our facility, or another trauma center in the area.  We keep segments aside of the units we give out and if they come to us we crossmatch but there is talk of removing that from the SOP.  We feel uncomfortable with that because we cant find much information other than the FDA wants traceability and trackability of the unit.   I feel like this situation is a black hole for units, not much information in the regulations/standards. 

[Ensis01]

It sounds like you are giving emergent uncrossmatched units, with an extra layer. So I would keep your current process. The only thing I would check that may be relevant is the point the patients get registered to your hospital. If they are on route to your hospital before the blood is given I would regard them as your patient, like a GSW walk in to the ER. 

[Mabel Adams]

We have a contract to provide blood to our air ambulances, but they charge the patient if they transfuse it (well, it's wrapped into their total charges for the flight, but we don't charge the patient).  If the patient comes to us, we do the XM like we would for our own UNXM units but if the patient is transported elsewhere, we maintain final disposition of the unit in our computer but don't do the XM (yes, we give the patient a fake account in the BB computer using a specific format).  It is just easier for us to maintain the record of the unit's final disposition for if there is a market withdrawal etc.  We would notify the air transport company to do the patient or next of kin notifications if that were ever needed. It hasn't happened yet so it isn't a big problem.

[OkayestSBB]

On 8/28/2022 at 4:50 PM, Mabel Adams said:

We have a contract to provide blood to our air ambulances, but they charge the patient if they transfuse it (well, it's wrapped into their total charges for the flight, but we don't charge the patient).  If the patient comes to us, we do the XM like we would for our own UNXM units but if the patient is transported elsewhere, we maintain final disposition of the unit in our computer but don't do the XM (yes, we give the patient a fake account in the BB computer using a specific format).  It is just easier for us to maintain the record of the unit's final disposition for if there is a market withdrawal etc.  We would notify the air transport company to do the patient or next of kin notifications if that were ever needed. It hasn't happened yet so it isn't a big problem.

Thank you for sharing this Mabel! Sounds like your facility is in a similar boat as ours.   By chance, are the units you provide ever returned to you if not used, prior to expiration? And do you ever accept them back into inventory for transfusion, or do you just discard them? 

[Mabel Adams]

On 8/30/2022 at 10:59 AM, OkayestSBB said:

Thank you for sharing this Mabel! Sounds like your facility is in a similar boat as ours.   By chance, are the units you provide ever returned to you if not used, prior to expiration? And do you ever accept them back into inventory for transfusion, or do you just discard them? 

We accept them back and use them.  We put Safe-T-Vue indicators on them, control the refrigerators at some hangars, validate their transport containers and have reviewed the procedures and documentation for storage at the other company's hangar.