Wertheimer G1, Balian F1, Parsell R1
1CareFlight , 2Westmead Hospital
Biography:
Dr Wertheimer is completing his Anaesthetic provisional fellowship with the CareFlight Rapid Response Helicopter and at Westmead Hospital, specialising in trauma management. He holds a Master of Traumatology and has worked in several high-volume trauma centres, including internationally. His clinical interests include major haemorrhage, prehospital resuscitation, and optimisation of early trauma care. He is actively involved in research focused on prehospital blood product and calcium administration. His work aims to translate evidence into practice and improve outcomes for critically injured patients across both retrieval and hospital trauma systems.
Abstract
Background:
Haemorrhage is a leading cause of preventable death following major trauma. Hypocalcaemia occurs in 83-86% of patients undergoing massive transfusion and contributes to coagulopathy, reduced myocardial contractility, and haemodynamic instability. Current military and civilian guidelines recommend empiric calcium administration during blood product resuscitation however, the optimal dosing strategy remains uncertain, particularly in the prehospital setting where no Australian evidence-based protocols exist.
Aims:
To describe prehospital calcium administration in trauma patients receiving blood products and inform development of an evidence-based replacement protocol.
Methods:
This retrospective observational cohort study includes adult trauma patients (≥18 years) treated by a physician-led prehospital trauma service who received prehospital blood product transfusion and were transported to a major trauma centre between January 2016 to December 2025.
Data collected from retrieval and hospital electronic medical records, include baseline population characteristics, pre-hospital transfusion products and volume, pre-hospital calcium administration, and initial blood gas on hospital arrival. The primary outcome is ionised calcium on initial blood gas in hospital.
Results (Expected):
We hypothesise that hypocalcaemia will be common at hospital arrival despite prehospital transfusion, suggesting inconsistent or insufficient calcium replacement.
Conclusion:
This study will evaluate current prehospital calcium replacement practices and support development of a standardised protocol to optimise early trauma resuscitation in patients receiving prehospital blood transfusions.