Enhancing our Critical Care Capability with the Carriage of Blood Products

June 9, 2016 by Tracy

Collaborative Effort by DSAA,DCH,DFW,HSF, SWASfTDorset and Somerset Air Ambulance is delighted to announce that a collaboration between the Charity, Dorset County Hospital, Devon Freewheelers, the South Western Ambulance Service NHS Foundation Trust (SWASfT) and the Henry Surtees Foundation, has resulted in patient’s now being able to receive blood products at the scene of an incident.

The project came to fruition when the Charity started carrying blood on 26 April 2016.  An official launch took place at the Charity’s airbase today, where all parties involved in the project, heard how their contribution is already making a difference to people's lives.

Emergency blood transfusions are usually given to patients who suffer life-threatening bleeding caused by major trauma or acute medical conditions.  40% of trauma deaths are due to bleeding, so being able to carry and administer blood products to these patients before they get to hospital could be a matter of life or death.

Ian Mew in simulation exerciseAfter months of research and a dedicated commitment to patient benefit; the Charity’s Critical Care Team have worked extremely hard on identifying the best way to deliver, implement and fund this project. Special recognition should be given to the work of Critical Care Paramedic, Michelle Walker and Air Ambulance Intensive Care Consultant, Dr Ian Mew.

Of the 20 air ambulance charities across the UK, Dorset and Somerset Air Ambulance joins 9 others who now carry blood products on board their aircraft and rapid response vehicles.  In a bid to ensure that patients in extremis have enough blood to keep them alive until they reach hospital, Dorset and Somerset Air Ambulance will carry four units of O type red blood cells, unlike many others who only carry two.

A further significant development is that ‘Freeze Dried Plasma’ will also be carried by Dorset and Somerset Air Ambulance from the month of June.Blood Transfusion simulation

Experience from the military suggests that if a patient is bleeding to death, they should receive both ‘packed red cells’ (which carry oxygen) and ‘plasma’ (which carries the clotting factors to help stop the bleeding).  Freeze Dried Plasma was selected as the preferred option to Fresh Frozen Plasma as it has a shelf life of approximately 18 months and can be made up when needed, unlike fresh frozen plasma which has a five day shelf-life after being thawed.  The Charity will become one of four air ambulance charities in the UK to carry a combination of blood and plasma and the only air ambulance charity in the South West to do so.

Developing the blood service comes at an expense.  It requires equipment within the hospital to pre-condition the blood, transportation to and from hospital to the airbase and a dedicated place of storage.  It also requires equipment to keep the blood cold on the aircraft and further specialist equipment which warms the blood as it is being transfused to the patient.

The Dorset and Somerset Air Ambulance team built key relationships with a number of different parties who have played a key role in the facilitation and funding of the project.

Mac Greenslade, John Thorne and Dr. Dietmar Hoffer (Dorset County Hospital), Mo Ayling (DFW) with Dr. Ian Mew and Dr. Rob TorokThe Transfusion Laboratory at Dorset County Hospital (DCH) has been extremely supportive of the project providing four units of O type blood to the Charity every 48 hours.  The blood is stored in temperature regulated ‘Golden Hour’ boxes which keep the blood under 6°C for up to 72 hours.  These boxes require conditioning in order to function (a process of freezing and partial thawing) using -30°C freezers provided specifically for this purpose.  The boxes are packed and sealed prior to dispatch by the DCH Transfusion Team and contain a temperature logging device which ensures the blood temperature is monitored for the duration that it is out of the hospital environment.

Motorcycle Charity, Devon Freewheelers deliver the blood to Dorset and Somerset Air Ambulance on blood bikes and in a newly Devon Freewheelers with Dr. Ian Mew and Critical Care Paramedic Claire Bakersponsored car.  This team of around 50 volunteer emergency vehicle drivers are dedicated to providing a weekday out of hours and 24/7 weekend service supporting the NHS by delivering essential Blood, Samples, Medication and Donor Breast Milk to and from hospitals across the South West.

If the ‘Golden Hour’ box is unopened at the end of the 48 hour period, it will be collected by the Devon Freewheelers and returned to DCH where it will be reissued and utilised within the hospital. Similarly, if blood is used during a shift, the Helicopter Emergency Medical Service Desk (HEMS) contact the DCH Transfusion Laboratory and the Devon Freewheelers deliver additional stocks within a matter of hours.

An application for funding of the project was submitted to the Henry Surtees Foundation which concluded in all the set up costs being fully funded by the foundation totalling nearly £18,000.  Further logistical support was shown when the Henry Surtees Foundation also agreed to cover the leasing costs of a Vauxhall Mokka 4x4 which is being used by the Devon Freewheelers as an additional resource to deliver and collect the blood.Henry Surtees Foundation Trustee Derek Redfern presents a cheque to DSAA CEO Bill Sivewright

The South Western Ambulance Service NHS Foundation Trust (SWASfT) has also been extremely supportive of the project.  The Trust is fortunate to be supported by five air ambulance charities; the largest number of charities of any UK ambulance service and is responsible for tasking all the air ambulances, clinical governance and employment of the paramedics.

Bill Sivewright, Dorset and Somerset Air Ambulance Chief Executive Officer said:  “To the lay person, the decision to carry blood in the Air Ambulance seems very straightforward.  However, in reality, it takes an enormous amount of careful consideration and detailed planning by a number of organisations to make it happen.  Bringing together the experience and expertise of the Air Ambulance, Dorset County Hospital, SWASfT and Devon Freewheelers and the generous support of the Henry Surtees Foundation, epitomises what can be achieved through good collaboration.  The whole really is much more than the sum of its parts and our patients will beaBill Sivewright with Lord Lieutenant of Dorset and DSAA Patron Angus Campbellr witness to that in the years to come.”

Dr. Ian Mew (Consultant in Anaesthetics & Intensive Care Medicine) spoke on behalf of Dorset County Hospital and said:   “Providing blood for the Dorset & Somerset Air Ambulance critical care team to give at the roadside is something that we’re particularly proud of. Our blood transfusion staff have worked very closely with the Charity over the past year, installing specialist equipment in the laboratory and developing processes to ensure the blood is kept according to very strict criteria whilst on the helicopter.  For the past three years, three of our consultants have been flying with the air ambulance and have been providing training for the critical care paramedics.  By combining this with the provision of blood, Dorset County Hospital is proud to be making a difference to the wider community and looks forward to working with the Charity to provide life-saving care into the future.”

SWASFT’s deputy clinical director, Adrian South, said: “SWASFT’s critical care specialist paramedics who work on the air ambulance receive additional training so they can bring even more clinical skills to the most seriously ill and injured patients. Along with critical care doctors, they are able to administer the blood. This new initiative to carry blood for transfusions will be of real benefit for patients in the south west.”

John Surtees CBE commented on the announcement and said: “With a background in motorsport, I have spent my life largely chasing time round the race tracks of the world.  I know that every second counts and none more so than for the Air Ambulance Services when accidents or illnesses occur.  I would like to say a special thank you to Vauxhall for supporting our initiative. I’m sure that the assistance of the Vauxhall Mokka will be a huge benefit to the region and help save multiple lives.”

Daniel Lavery, Founder and Chief Executive of Devon Freewheelers, said: “Blood is crucial for the Helimed team so that they can carry out emergency blood transfusions for patients who suffer major trauma.  We’ve been providing this service for the NHS in the South West for years, but this new function means that even those who have accidents in remote locations can receive life-saving blood as quickly as possible. It’s a pleasure to now be working alongside Dorset and Somerset Air Ambulance.”

Photographs taken at the official announcement of the project can be viewed by clicking HERE.