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PHARM Podcast 154 There will be blood (Part1)

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Hi folks

on todays episode I talk about emergency whole blood donation for life saving transfusion in remote and austere settings.

Heres the articles links:

Emergency Whole Blood use in the Field: A Simplified Protocol for Collection andTransfusion

Blood Transfusion on Cruise Ships;A 36 month Review of Preliminary Data

Warm Fresh Whole Blood Is Independently Associated With Improved Survival for Patients With Combat-Related Traumatic Injuries

Podcast ( available here and on iTunes)

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11 Comments Post a comment
  1. Grant Jonsson, MSc, CC-paramedic #

    Why is helicopter transport discouraged?

    October 29, 2016
    • Huh?

      October 29, 2016
      • Grant Jonsson, MSc, CC-paramedic #

        Doctor…In the Royal Caribbean presentation, the second or third slide from last – take a look. It very clearly discourages helicopter transport from ship to shore, and I was just trying to figure out the physiology..Grant Jonsson

        October 30, 2016
      • Grant Jonsson, MSc, CC-paramedic #

        Doctor…It’s the third one from the end, and is titled “Avoid Helicopter Transport”. It shows a US Coast Guard helicopter, and maybe their point is that it is difficult to land on a ship because the helicopter is not right on the “H”. I really only noticed that when I looked at the picture so I could tell you definitively what slide to look at, and after I had written my first reply to “Huh?”. My thought was something to do with flight physiology, or something I had not considered medically. If it really is the fact that the helicopter is not right on the “H” then perhaps they were just trying to inject humour or something. I don’t know…Grant

        October 30, 2016
      • yes its due to risks of landing on a ship, let alone the risk of trying to reach a ship at sea by air with a rotary wing. Also winching a shocked patient onto a helicopter can be fatal as body doesnt tolerate the forces all that well!

        October 30, 2016
    • R #

      The US Coast Guard, which provides SAR to much of the Caribbean, does not land helicopters on cruise ships. All patients are winched in a litter (without an attendant) or basket depending on how ambulatory they are which is very high risk. The USCG may be able occasionally provide a skilled clinician on the helicopter but usually it is an EMT with an extremely limited scope of practice. If the cruise ship provides a clinician to escort the patient in addition to enduring the risks of being hoisted themselves they are unavailable to rest of the ship’s crew/passengers and also operating in an unfamiliar environment.

      Presumably the controlled clinical environment with multiple skilled clinicians is better for the patient, especially when not much time will pass before the next port call. R

      October 31, 2016
      • Thanks!

        October 31, 2016
      • Grant Jonsson, MSc, CC-paramedic #

        Thank you. I didn’t know that the Coast Guard did not land on the ship. Not quite sure why, in good weather, but now I know.

        October 31, 2016
  2. Grant Jonsson, MSc, CC-paramedic #

    Doctor…In reading the “shownotes” I see the statement “There is scant evidence
    to support, in a field environment, that a whole blood based resuscitation strategy is superior to a crystalloid/colloid approach even when augmented by a limited number of RBC and plasma units.” Is this simply because there is not yet enough experience to make a more definitive statement?

    October 29, 2016
    • Research is difficult in this area . Rapid evacuation and better body armour has meant since Vietnam war , survival from penetrating trauma has increased therefore difficult to prove one fluid resuscitation works better as overall care has improved . Civilian trauma care switched away from using whole blood due to logistics and economics so hard to study it compared to other strategies that are cheaper

      October 29, 2016
    • In mildly bleeding trauma pt , it probably doesn’t matter as you likely don’t need any fluid resuscitation . Transfusion triggers we now know need not be so aggressive as folks can tolerate anaemia better than we thought

      October 29, 2016

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