title: Army Air Ambulance Blood Product Program in the Combat Zone and Challenges to Best Practices.
abstract: BACKGROUND
  Identify challenges and best practices in the development of an austere air ambulance transfusion program.
  
  
  METHODS
  A search of PubMed using combinations of the key terms 'prehospital,' 'blood product,' 'red blood cells,' 'damage control resuscitation,' 'transfusion,' 'air ambulance,' 'medical evacuation,' and 'medevac' yielded 196 articles for further analysis, with 14 articles suitable for addressing the background of prehospital transfusion within a helicopter. Retrospective analysis of unclassified briefs, after action reports, and procedures was also undertaken along with interview of subject matter experts. The initial series of 15 transfusions were discussed telephonically among flight crew, trauma surgeons, and lab specialists. Review of Joint Theater System data was readily available for 84 U.S. Army air ambulance transfusions between May-December 2012, with December marking the redeployment of the 25(th) Combat Aviation Brigade.
  
  
  RESULTS
  Standardized implementation enabled safe blood product administration for 84 causalities from May-December 2012 without blood product shortage, expiration, or transfusion reaction. Challenges included developing transfusion competency, achieving high quality blood support, countering the potential for anti-U.S. sentiment, and diversity in coalition transfusion practices.
  
  
  CONCLUSIONS
  Blood product administration aboard the air ambulance is logistically complex, requiring blood bank integration. Repetitive training enabled emergency medical technicians (EMTs) with basic medical training to safely perform transfusion in accordance with clinical operating guidelines. In the austere environment, logistic factors are significant challenges and political sensitivities are important considerations. Best practices may facilitate new en route transfusion programs. Powell-Dunford N, Quesada JF, Gross KR, Shackelford SA. Army air ambulance blood product program in the combat zone and challenges to best practices. Aerosp Med Hum Perform. 2016; 87(8):728-734.
authors.affiliation: U.S. Army Aeromedical Research Laboratory, Ft Rucker, AL, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Powell-Dunford
authors.forename: Jose F
authors.initials: JF
authors.lastname: Quesada
authors.forename: Kirby R
authors.initials: KR
authors.lastname: Gross
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Shackelford
mesh_terms: D017732:Air Ambulances; D000465:Algorithms; D001800:Blood Specimen Collection / Q000379:methods*; D001803:Blood Transfusion / Q000379:methods*; D004634:Emergency Medical Technicians / Q000193:education; D006801:Humans; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel / Q000193:education; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States; D014857:Warfare