Blood for helicopters

[adiescast]

We are starting discussions about making emergency blood available to the helicopter crew to take to scenes. Is anyone willing to share their process for this? Are there any issues you had to resolve that I should be aware of?

Thanks in advance!

[David Saikin]

We deal with helicopters from our referral facility. They bring 2-3 O=rbc for emergecny transfusion. They do not want to transport blood from our facility as there is no room in the copter for the box. You might try contacting the DHART program at Dartmouth Hitchcock Medical Center (as they are the helicopter peoptle). 603-650-5000.

[kate murphy]

We have several helicopters. We probably have 10-15 patients daily coming in by Medflight. We do not provide blood for any of them. We do provide albumin, and even that is a headache to track. They use crystalloid/colloid to support patients till they get to us. The ER notifies us when Medflight is coming and we have blood waiting in the ER.

If a patient is transported from another facility to us, occasionally they will send blood with the patient. Not often. We do not accept unused blood on these occasions as we have no idea how it's been stored during flight.

[tbostock]

I believe you have to be FDA licensed to ship blood in order to send blood in a helicopter to another hospital. Also, check your state regs; here in NY State, they are considering making regs that ambulance/helicopter personnel will have to have competencies before they can transfuse.

We sign it out to the ER and try to get them to transfuse it before helicopter transport to the other hospital.

[adiescast]

We actually do not plan to ship blood to other hospitals. If they hang the blood in the helicopter, the blood will go with the patient, but it will be billed for the helicopter flight. Unused blood comes back to us and does not stay at the other hospital. Most of the flights are expected to come back to our hospital anyway.

The competencies issue is important. I will check into that. Some of the nurses work part time here in addition to working for the helicopter company, so they will get our standard CBT competencies. I will have to figure out what to do with the others.

[donnalander]

There is a large hosptial, ~ 70 miles from our facility; they keep a helicopter here and also provide us with 4 units of O Neg blood (they switch it out on a weekly basis). The large hospital provides a log to "sign out" the units when needed, and a cooler that has been validated for 24 hours; it is called the Credo Cube and utilizes Golden Hour technology. The process works well, we've had only rare problems with it (units out >24 hrs).

[Mabel Adams]

I've heard that helicopter crews don't check ID and assume whatever is in the cooler is right for their patient. I've heard it recommended to always send universal donor blood even if it is crossmatched. Not a bad approach to all emergencies. Can you imagine someone grabbing a cooler in ER and putting it on a helicopter with a patient when it was really blood for a crossmatched A pos patient in the ER, not the one being shipped? Maybe competencies are a better approach.

[heathervaught]

We support a few helicopter operations. There is a (temperature monitored) blood refrigerator at the hangar that is stocked by a local hospital with 2 O neg and 2 O pos. The units are rotated frequently to prevent outdating.

[adiescast]

We support a few helicopter operations. There is a (temperature monitored) blood refrigerator at the hangar that is stocked by a local hospital with 2 O neg and 2 O pos. The units are rotated frequently to prevent outdating.

Do you know how they carry the blood on the helicopter (type of cooler, any indicators, etc.)?

[donnalander]

Ours uses a cooler made by "Golden Hour" called the Credo."; apparently this technology was developed for military transport. It is validated for 24 hrs; I believe there are several variations of this cooler. Google "Golden Hour Blood Container".

[heathervaught]

I am told that they use a robust cooler, but not the Golden Hour cooler. No temperature indicators are placed in/on the units themselves. If the blood arrives at the receiving hospital and is not used, then the receiving hospital (same parent company owns the hospital and the helicopter service) checks the temp and places into inventory if acceptable, then provides fresh units for the hangar.

[adiescast]

My helicopter team is proposing actually sealing the units in tamper evident packages so that we know if they opened them. I'm not sure how relevent that is, since it would not tell me if they took the packet out of the cooler. It would, however, protect the ports if they took it out of the cooler at a scene and returned it to the cooler again.

[heathervaught]

The ports already have a tamper-evident seal around them. I'm not sure that would accomplish anything...

[velliott]

Joint commission says that all staff that transfuse have to have competency. They also need to recognise signs and symptoms of reactions. If we send someone in an ambulance to the heli-pad we send one of our nursing staff to monitor the patient since they have had competencies and then they try to get the unit in before they hand them off. If by chance the staff has to take them with the unit hanging I hope an inspector would understand that it is a life and death situation. It's been my experience that helicopter staff have competency for transfusions. I don't know if this is something that is unique to my area or not.