Risk management analysis of air ambulance blood product administration in combat operations

Nicole Powell-Dunford, Jose F. Quesada, Robert F. Malsby, Victoria Chou, Robert T. Gerhardt, Kirby R. Gross, Stacy A. Shackelford

Research output: Contribution to journalArticle


Background: 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. Methods: 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. Results: 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. Discussion: 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.

Original languageEnglish (US)
Pages (from-to)1130-1135
Number of pages6
JournalAviation Space and Environmental Medicine
Issue number11
StatePublished - Jan 1 2014
Externally publishedYes


  • Blood
  • Medevac
  • Pre-hospital
  • Resuscitation
  • Transfusion

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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  • Cite this

    Powell-Dunford, N., Quesada, J. F., Malsby, R. F., Chou, V., Gerhardt, R. T., Gross, K. R., & Shackelford, S. A. (2014). Risk management analysis of air ambulance blood product administration in combat operations. Aviation Space and Environmental Medicine, 85(11), 1130-1135. https://doi.org/10.3357/ASEM.3851.2014