The introduction of on-scene blood transfusion in a civilian physician-led pre-hospital trauma service

Background London’s Air Ambulance (LAA) teams attend over 2000 trauma missions per year. Ten percent of patients suffer from serious haemorrhage. Since 2008, physician-led pre-hospital teams have activated “Code Red – massive haemorrhage protocol” pre-alerts to the Major Trauma Centres in London.[1] A significant number of seriously injured patients die at the scene of the incident. Major haemorrhage contributes to a proportion of these deaths and until recently, fluid resuscitation consisted of crystalloid infusion. Studies have demonstrated dismal outcomes from hypovolaemic traumatic arrest.[2] In March 2012, LAA became the first service in the United Kingdom to routinely carry emergency O Negative blood (packed red blood cells PRBC). Indications to transfuse include traumatic arrest where hypovolaemia is a contributing factor or patients who meet Code Red criteria and require volume resuscitation prior to hospital. Our aim was to examine the impact of on-scene blood transfusion for seriously injured patients.