Back to the Future - the evolution of blood and blood product use in a prehospital and retrieval service
SAAS Medstar, James Cook University
I am currently the Nursing Director for SAAS MedSTAR Emergency Medical Retrieval. My background is in emergency, trauma, prehospital and retrieval nursing. I am a Nursing Officer and instructor for the Military Critical Care Aeromedical Evacuation team, No. 3 Aeromedical Evacuation Squadron, Royal Australian Air Force and have teaching responsibilities with James Cook University, specifically the Post Graduate Certificate in Aeromedical Retrieval. Further, I am an AusMAT Clinical Team Leader with deployments to Banda Aceh post the Boxing Day Tsunami and more recently to Fiji post Tropical Cyclone Winston.
Prehospital and retrieval services in South Australia have been transporting and administering blood and blood products for over 30 years and the model of haemovigilance has evolved.
Forming part of the South Australian Ambulance Service’s (SAAS) Rescue, Retrieval and Aviation Services directorate, MedSTAR Emergency Medical Retrieval is South Australia’s prehospital and retrieval service caring for neonate, paediatric and adult patients, across all transport modalities, with central clinical coordination. Since SAAS MedSTAR’s inception in 2009, we have utilised several different methods of blood and blood product management.
SAAS MedSTAR has transitioned from local shipper packing, to remote packing by a transfusion unit and daily shipper rotation, returning to local management and packing by the team prior to mobilising once activated for a task.
Since the current blood and blood product management system has been instituted, there have been:
- 220 packed red blood cell (PRBC) units delivered/rotated
- 55 clinical usage events
- 88 PRBC units transfused
- 3 PRBC units wasted
- 1.4% wastage rate
When retrieving a patient experiencing a catastrophic haemorrhage event from a remote or regional setting, where local stores of emergency PRBC units are exhausted, SAAS MedSTAR also provides a re-supply function in these instances. Country Health South Australia Local Health Network uses a Critical Bleeding Event template as a trigger for massive transfusion, but also as a trigger for re-supply.
This paper will describe the evolution of blood and blood product management and clinical use and how the current system has learnt from the past, establishing an effective and safe process and hint at innovative and exciting future capabilities.