O Negative PRBC's with MedFlight

[rmblack]

Our MedFlight team has approached me with possibility of carrying O Neg cells on their helicopter.

 

Does anyone have any expierence in dealing with this situation?

 

I have a hundred questions.

 

Thanks

 

Michael

Joplin, MO

[David Saikin]

How are they going to be stored (not transported)?  Storage at 1-6C.  You might want to contact the DHART team at Dartmouth-Hitchcock Med Ctre in Lebanon, NH.  I believe they carry up to 3 O=s when the situation warrants it, not all the time.  They can probably give you good first hand advice.

[tbostock]

We would not have O Neg units to waste. As they do not have proper storage for red cells on their flights, all unused units would be trashed.

When we are transporting a patient to a higher level of care at another hospital:

1. Going by ambulance: no blood can be transfused as an RN is not present.

2. Going by StatFlight: blood can be hanging as there is an RN present. Any unused units are discarded as soon as they land as the other hospital cannot accept them. Sadly, we hardly ever get our paperwork back but we document that in our LIS.

[nicholst]

Yes our healthnet does take 2 O negative RBCs with them when they fly. They have Credo coolers from Minnesota Thermal Science. They are validated by the blood bank. The flight crew takes care of freezing the cooler inserts by following a schedule that was prepared by myself. The crew has to return the units to the blood bank any time there is not going to be staff at healthnet and also when they have only two weeks left on their shelf life.

 

[tkakin]

We provide 2 Oneg units to Lifeflight.  They keep the units at home base until they get a call then they are packed in a cooler.  We have Saf -T-Vue indicators 10C. on the units as well.   If they patient is transfused in the field and the patient is taken to a different facility then we charge the units to lifeflight.  If the patient is brought to our facility we have them drawn and worked up. We require that they change out the units within 10 days of expiration if they are not used. 

takin@pathregional.com if you have specific questions for me.

 

Teresa

[Malcolm Needs ☆]

A couple of our hospitals have just introduced blood to our helicopters, and I heard Sue Mitchell give a brilliant talk about it just last Thursday.

 

I am certain that she would be happy to answer any questions.  Her address is;

 

Sue Mitchell,  Blood Transfusion Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, TN24 0LZ, England.

[tbostock]

This goes back to the whole 6 vs 10 degrees debate. If it's in a cooler, technically it is considered storage, even though they are transporting the blood. If monitoring the temp, you may have to get 6 degree indicators. Or maybe investigate putting a data logger in the cooler that would give you a chart of temps throughout the storage of the products.

[AMcCord]

We are in a rural area 100 miles from the big city. One of our neighbors (even farther from the big city) has a life flight which carries blood with them when they pick up patients at very small facilities or if they make pickups at the site of accidents.

[rmblack]

This goes back to the whole 6 vs 10 degrees debate. If it's in a cooler, technically it is considered storage, even though they are transporting the blood. If monitoring the temp, you may have to get 6 degree indicators. Or maybe investigate putting a data logger in the cooler that would give you a chart of temps throughout the storage of the products.

 

I know...I struggle with that argument.  I don't know if I should make them come to blood bank each time or if I should let them have a freezer in their respective area.  I could put a portable graph recorder in it but then some alarm would have to be tied into the switch board or the units would have to be returned to the BB while the department was left empty.

 

The data logger is a great idea.  I can validate a separate cooler for "transportation" while in flight but I can't validate it for every season/weather change.  I don't believe the inside of the helicopter is a temperature controlled environment but I could be wrong.  Just looked at the Credo cooler.  That may be the ticket.

 

Who gives the order to transfuse?  Do you have trouble with wastage?  I like the idea of billing medflight if they are wasted or the patient is taken to another facility.

 

What about competency of transfusing staff? I believe CAP requires competency documentation of transfusing staff at least yearly. 

 

 

Thanks for all the ideas and input.

[adiescast]

We send 2 units of O Negatives with every flight. We use the Credo Coolers, which we validated to 36 hours at 1 - 6 C. We sign out the units for 12 hour intervals, give or take depending on their schedule. They switch out the frozen inserts when they come for the next set of units. They take 4 hour temperatures of the coolers using an inside/outside thermometer that does not require opening the cooler to read. The temperature records are stored in blood bank. We do put Safe-T-Vue indicators on the units, but that is more to show if the units were removed from the cooler and might have gone out of temperature (they are 1 - 10 C indicators). We do return the units to inventory if they are not used. We charge them to the helicopter company if they are wasted or taken to another hospital.

[adiescast]

I know...I struggle with that argument.  I don't know if I should make them come to blood bank each time or if I should let them have a freezer in their respective area.  I could put a portable graph recorder in it but then some alarm would have to be tied into the switch board or the units would have to be returned to the BB while the department was left empty.

 

The data logger is a great idea.  I can validate a separate cooler for "transportation" while in flight but I can't validate it for every season/weather change.  I don't believe the inside of the helicopter is a temperature controlled environment but I could be wrong.  Just looked at the Credo cooler.  That may be the ticket.

 

Who gives the order to transfuse?  Do you have trouble with wastage?  I like the idea of billing medflight if they are wasted or the patient is taken to another facility.

 

What about competency of transfusing staff? I believe CAP requires competency documentation of transfusing staff at least yearly. 

 

 

Thanks for all the ideas and input.

 

 We require the same competency of the helicopter crew that we require of our other transfusing staff. They maintain the documentation.

[tkakin]

Who gives the order to transfuse?  I believe the RN's on the hellicopter are in communication with the ER they intend to transport the patient to, and getting the order to transfuse. Good Question. I will investigare this more. Do you have trouble with wastage?  No they are very good at taking care of the products. I like the idea of billing medflight if they are wasted or the patient is taken to another facility.

 

What about competency of transfusing staff? Hmmm another good question that I am sure has been looked at by my previous supervisor, but I do not know how that is being tract.I believe CAP requires competency documentation of transfusing staff at least yearly. 

[Mabel Adams]

I don't think CAP can regulate a helicopter company you are selling blood to for transfusion.  Transfusion competency should happen, but I am not sure that the sending Lab is responsible for it.

They keep the blood in a monitored blood fridge in the hangar and pack it in a credo when they go out with it.  They wanted to keep it in the credo all the time for days (ony changing the insulators daily). They park the helicopter outside on the tarmac in summer so I didn't see how I could validate the credo cubes for those conditions.  Also, that would definitely be storage and we are required to have continuous monitoring and alarms for storage.  I am thinking of telling them to keep the Credo packed with the blood in the fridge so it is faster to get ready to go.