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Blood on board

Blood Bank and Stem Cell Bank Discipline Manager Beverly Craig outlines an innovative project with the emergency services.

The Northern Ireland Helicopter Emergency Medical Service (HEMS) was launched in July 2017. It operates between the hours of 7am and 7pm. It provides pre-hospital care to patients who have sustained serious trauma. A significant number of these patients have life-threatening haemorrhages, which must be rapidly controlled. The HEMS team has the ability to administer pre-hospital tranexamic acid, together with the application of haemorrhage control interventions. Statistics have shown early administration of red blood cells (RBCs) may confer a survival benefit. Indications for pre-hospital transfusion include:  

  • Systolic BP <90mmHg with suspected active haemorrhage.  
  • Traumatic cardiac arrest where hypovolaemia is considered a contributory factor and the patient may be salvageable. Over the course of a year, key stakeholders met with the objective of establishing a HEMS pre-hospital blood transfusion service for Northern Ireland, including Northern Ireland Blood Transfusion Service (NIBTS), Belfast Health and Social Care Trust (BHSCT) Blood Bank and Haemovigilance Team, Northern Ireland Transfusion Committee and the Henry Surtees Foundation. The project successfully went live in December 2019.

Substantial costs were involved and a successful application was submitted for funding from the Henry Surtees Foundation – a charitable organisation founded by motor sport legend, John Surtees CBE, following the tragic death of his son,who was killed aged 18, while competing in a Formula 2 race in 2009. This funding enabled the purchase of a number of items, including a blood bank freezer, temperature-monitoring equipment, six HEMS transport boxes and blood warming units. The funding also covered costs associated with blood bank staff and the projected overall costs for the first five years. Temperature data loggers were donated.

Training and Competency

Prior to go-live, a robust framework and governance structure conforming to Medicines and Healthcare products Regulatory Agency (MHRA) requirements was essential. A collaborative training day was held with the HEMS doctors and paramedics, good manufacturing practice (GMP) training and training on the importance of pre-transfusion sampling was provided by the blood bank. Haemovigilance delivered a dedicated session called “safe transfusion practice”, applicable to the pre-hospital setting.

E-learning was also completed in line with Better Blood Transfusion 3 NI requirements for Right Patient Right Blood (RPRB). Selected HEMS staff were trained as RPRB assessors, who then carried out one-to-one staff simulated competency assessments.

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