Prehospital administration of blood products: experiences from a Finnish
physician-staffed helicopter emergency medical service

Prehospital administration of blood products: experiences from a Finnish
physician-staffed helicopter emergency medical service

: Prehospital blood products, Red blood cells, Freeze dried plasma, Helicopter emergency medical
services, HEMS

Background: Massive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome. Military
experience suggests avoiding crystalloids using early damage control resuscitation with blood components in out
of hospital setting. Civilian emergency medical services have since followed this idea. We describe our red blood
cell protocol in helicopter emergency medical services (HEMS) and initial experience with prehospital blood
products from the first 3 years after implementation.
Methods: We performed an observational study of patients attended by the HEMS unit between 2015 and 2018 to
whom packed red blood cells, freeze-dried plasma, or both were transfused. The Student’s two-sided T-test was
used to compare vitals in prehospital phase with those at the hospital’s emergency department. A p-value < 0.05
was considered significant.
Results: Altogether, 62 patients received prehospital transfusions. Of those, 48 (77%) were trauma patients and
most (n = 39, 81%) suffered blunt trauma. The transfusion began at a median of 33 (IQR 21–47) minutes before
hospital arrival. Median systolic blood pressure showed an increase from 90 mmHg (IQR 75–111 mmHg) to 107
mmHg (IQR 80–124 mmHg; P < 0.026) during the prehospital phase. Four units of red blood cells were handled
incorrectly when unused red blood cells were returned and required disposal during a three-year period. There
were no reported adverse effects from prehospital transfusions.
Conclusion: We treated two patients per month with prehospital blood products. A prehospital physician-staffed
HEMS unit carrying blood products is a feasible and safe method to start transfusion roughly 30 min before arrival
to the hospital.
Trial registration: The study was retrospectively registered by the Tampere University Hospital’s Medical Director
(R19603) 5.11.2019.

Pauli Vuorinen , Joonas-Eemeli Kiili, Piritta Setälä, Antti Kämäräinen and Sanna Hoppu

BMC Emergency Medicine

(2020) 20:55

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