Powell-Dunford Nicole, Quesada Jose F, Malsby Robert F, Chou Victoria, Gerhardt Robert T, Gross Kirby R, Shackelford Stacy A
U.S. Army Health Clinic, Schofi eld Barracks, Wahiawa, HI, USA.
Aviat Space Environ Med. 2014 Nov;85(11):1130-5. doi: 10.3357/ASEM.3851.2014.
Between June-October 2012, 61 flight-medic-directed transfusions took place aboard U.S. Army Medical Evacuation (medevac) helicopters in Afghanistan. This represents the initial experience for pre-hospital blood product transfusion by U.S. Army flight medics.
We performed a retrospective review of clinical records, operating guidelines, after-action reviews, decision and information briefs, bimonthly medical conferences, and medevac-related medical records.
A successful program was administered at 10 locations across Afghanistan. Adherence to protocol transfusion indications was 97%. There were 61 casualties who were transfused without any known instance of adverse reaction or local blood product wastage. Shock index (heart rate/systolic blood pressure) improved significantly en route, with a median shock index of 1.6 (IQR 1.2-2.0) pre-transfusion and 1.1 (IQR 1.0-1.5) post-transfusion (P < 0.0001). Blood resupply, training, and clinical procedures were standardized across each of the 10 areas of medevac operations.
Potential risks of medical complications, reverse propaganda, adherence to protocol, and diversion and/or wastage of limited resources were important considerations in the development of the pilot program. Aviation-specific risk mitigation strategies were important to ensure mission success in terms of wastage prevention, standardized operations at multiple locations, and prevention of adverse clinical outcomes. Consideration of aviation risk mitigation strategies may help enable other helicopter emergency medical systems to develop remote pre-hospital transfusion capability. This pilot program provides preliminary evidence that blood product administration by medevac is safe.
2012年6月至10月期间，美国陆军医疗后送直升机在阿富汗执行了61次由飞行军医指导的输血任务。这代表了美国陆军飞行军医在院前输血方面的初步经验。
我们对临床记录、操作指南、行动后评估、决策和信息简报、双月医疗会议以及与医疗后送相关的医疗记录进行了回顾性审查。
在阿富汗各地的10个地点实施了一个成功的项目。对输血适应症方案的遵守率为97%。有61名伤员接受了输血，没有任何已知的不良反应或当地血液制品浪费的情况。休克指数（心率/收缩压）在途中显著改善，输血前中位数休克指数为1.6（四分位间距1.2 - 2.0），输血后为1.1（四分位间距1.0 - 1.5）（P < 0.0001）。在10个医疗后送行动区域中的每个区域，血液补给、培训和临床程序都实现了标准化。
医疗并发症的潜在风险、反向宣传、对方案的遵守以及有限资源的转移和/或浪费是试点项目制定过程中的重要考虑因素。特定于航空的风险缓解策略对于确保任务成功非常重要，包括预防浪费、在多个地点实现标准化操作以及预防不良临床结果。考虑航空风险缓解策略可能有助于其他直升机紧急医疗系统发展远程院前输血能力。这个试点项目提供了初步证据，证明医疗后送过程中血液制品的输注是安全的。
