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Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study
- Felicia M. Mix, Martin D. Zielinski, Lucas A. Myers, Kathy S. Berns, Anurahda Luke, James R. Stubbs, Scott P. Zietlow, Donald H. Jenkins, Matthew D. Sztajnkrycer
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 3 / June 2018
- Published online by Cambridge University Press:
- 19 April 2018, pp. 230-236
- Print publication:
- June 2018
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- Article
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Introduction
Hemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).
MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).
ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.
ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.
,Mix FM ,Zielinski MD ,Myers LA ,Berns KS ,Luke A ,Stubbs JR ,Zietlow SP ,Jenkins DH .Sztajnkrycer MD Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study . Prehosp Disaster Med.2018 ;33 (3 ):230 –236 .
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. 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- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Effects of Pre-Process Temperature Stressing on AlGaN/GaN HEMT Structures
- Mark J. Yannuzzi, Neil A. Moser, Robert C. Fitch, Gregg H. Jessen, James K. Gillespie, Glen D. Via, Antonio Crespo, Thomas J. Jenkins, David C. Look, Donald C. Reynolds
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- Journal:
- MRS Online Proceedings Library Archive / Volume 764 / 2003
- Published online by Cambridge University Press:
- 01 February 2011, C4.2
- Print publication:
- 2003
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In an effort to investigate the stability of the surface and hetero-interface of AlGaN/GaN HEMTs during high temperature device processing steps, AlGaN/GaN HEMT samples were subjected to temperatures from 650°C to 1150°C for a period of 30 seconds prior to processing. Hall and photoluminescence measurements were performed on samples before and after temperature stressing. The samples annealed at 700°C and 1150°C were then processed, and electrical parametric data were collected during and after processing. Large increases in HEMT Schottky gate diode reverse leakage current are observed at higher pre-process annealing temperatures, while the low-field mobility decreases.