Here we explain the different types of blood products, drugs and equipment that we use to help bleeding patients. We also highlight the importance of research and say thank you to those who donate their blood to help others.

Dorset and Somerset Air Ambulance (DSAA) operates under the clinical governance of the South Western Ambulance Service NHS Foundation Trust (SWASfT). We also adhere to the blood transfusion training policies of Dorset County Hospital and handle the blood in accordance with strict policy from the Medicines & Healthcare products Regulations Agency. Our critical care team attend regular training sessions to keep fully up to speed with the latest evidence, protocols and policies. All our blood transfusions are audited. Follow-up data regarding patient injury severity and survival outcome is analysed with support from our regional major trauma centres. This helps to establish whether what we are doing is saving lives, while constantly looking for ways to improve our patient care.

The Helicopter Emergency Medical Service (HEMS) desk, based at the ambulance service control centre, task DSAA to incidents. When blood is given to a patient, our critical care team will notify the HEMS desk, who will organise for the transfusion laboratory at Dorset County Hospital to prepare more blood products and for the Devon Freewheelers to transport it to our airbase.

Blood products we carry to help bleeding patients DSAA operates in a very rural environment. The major trauma centres who receive severely injured patients in the South West are located at Southampton, Bristol and Plymouth. That’s why our critical care team need to be able to stop active bleeding and carry enough blood products so that we can get patients to any one of these major trauma centres alive. The blood products we carry on DSAA include:

Plasma

Plasma is a yellow fluid, which is a component of whole blood. It is separated from donated blood by NHS Blood & Transplant. Plasma not only helps to re-fill the patient’s blood vessels after significant blood loss, but crucially helps the body to form clots at the injury site to stop bleeding.

Red Blood Cells

Red blood cells are another component of whole blood and are the main mechanism by which the body transports oxygen to the tissues. DSAA carries O positive and O negative blood, which can be given to men, women and children without the need for crossmatching. We carry four units of red blood cells and four units of plasma, split evenly between two shock packs.

Fibrinogen

Fibrinogen helps to form the scaffolding required for the body to form a clot. It binds platelets and other blood proteins to form a plug, but in low levels can be a cause of continued bleeding. By administering fibrinogen to bleeding patients, our critical care team are helping to maintain sufficient clotting proteins within the body to help reduce and even prevent further blood loss.

Lyoplas

Sometimes despite carrying all the above, our critical care team need even more help to get a bleeding patient to hospital alive. Therefore, we carry Lyoplas, which is a freeze-dried plasma, that can be reconstituted at the roadside. The beauty of Lyoplas is that it lasts for 18 months and therefore can be used if further blood products are required.

Specialist Equipment and Drugs used to help Bleeding Patients

While our critical care team are preparing to transfuse blood products, attempts are made to stop the bleeding by using drugs to help the patient’s blood to clot and devices to stop the bleeding mechanically. These include a drug called tranexamic acid, which helps to prevent the body from breaking down its own clots. It is given first, when a patient is suspected of bleeding due to trauma. Splints and binders can help to reduce bleeding from a broken pelvis or large bone. Specialist clotting dressings, emergency bandages and tourniquets can be applied directly to actively bleeding areas and the use of ultrasound machines can help to detect bleeding inside the patient, which would otherwise go unseen from the outside. Patients are always kept warm using a Blizzard heat blanket and blood warming devices help the body to clot.

Evidence and Research of Pre-Hospital Blood Transfusions

Our team are always looking for ways to ensure that best practice is used on every patient. As blood transfusions in the pre-hospital environment are a reasonably new phenomenon, we not only analyse data from the patients who have received blood products from our own team, but are actively involved in research on a national scale, to evidence what protocols, products, practices, policies and procedures give our patients the best chances of survival. This year, DSAA will join nine other air ambulance charities as part of a national trial, to determine whether giving whole blood (containing red cells, plasma and platelets all together) improves a patient’s chance of survival. We will be sharing more information on this in due course. Thank you Some of our clinical team remember the days when DSAA did not carry blood and the helplessness they felt, as patients died in front of their eyes due to blood loss. Thankfully, this is now becoming a rare occurrence. On behalf of all the patients we have treated with a transfusion and the many more that will need this in the future, we thank everyone that is involved with making it happen.