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Characteristics and outcomes of patients administered blood in the prehospital environment by a road based trauma response team
  1. Daniel Bodnar1,2,3,
  2. Stephen Rashford1,2,
  3. Catherine Hurn2,
  4. Jamie Quinn1,
  5. Lachlan Parker1,
  6. Katherine Isoardi1,4,
  7. Sue Williams5
  1. 1Queensland Ambulance Service, Brisbane, Queensland, Australia
  2. 2Department of Emergency Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
  3. 3Department of Emergency Medicine, Redcliffe Hospital, Redcliffe, Queensland, Australia
  4. 4Department of Emergency Medicine, The Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  5. 5Pathology Queensland Central Transfusion Laboratory, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
  1. Correspondence to Dr Daniel Bodnar, Department of Emergency Medicine, Royal Brisbane & Women's Hospital, Herston, Queensland 4006, Australia; daniel.bodnar{at}dcs.qld.gov.au

Abstract

Objective To describe the characteristics, clinical interventions and the outcomes of patients administered packed red blood cells (pRBCs) by a metropolitan, road based, doctor-paramedic trauma response team (TRT).

Methods A retrospective cohort study examining 18 months of historical data collated by the Queensland Ambulance Service TRT, the Pathology Queensland Central Transfusion Laboratory, the Royal Brisbane and Women's Hospital and the Princess Alexandra Hospital Trauma Services was undertaken.

Results Over an 18-month period (1 January 2011 to 30 June 2012), 71 trauma patients were administered pRBCs by the TRT. Seven patients (9.9%) died on scene and 39 of the 64 patients (60.9%) transported to hospital survived to hospital discharge. 57 (89.1%) of the transported patients had an Injury Severity Score (ISS) > 15, with a mean ISS, Revised Trauma Score (RTS) and Trauma-Injury Severity Score of 32.11, 4.70 and 0.57, respectively. No patients with an RTS < 2 survived to hospital discharge. 53 patients (82.8%) received additional pRBCs in hospital with 17 patients (26.6%) requiring greater than 10 units pRBCs in the first 24 h. 47 patients (73.4%) required surgical or interventional radiological procedures in the first 24 h.

Conclusions There is a potential role for prehospital pRBC transfusions in an integrated civilian trauma system. The RTS calculated using the initial set of observations may be a useful tool in determining in which patients the administration of prehospital pRBC transfusions would be futile.

  • Trauma
  • pre-hospital
  • resuscitation
  • emergency ambulance systems

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