Background/Case Studies: Geisinger Life Flight has pioneered medical air transport in Northeast and Central Pennsylvania for 43 years, transporting over 90,000 patients with 9 helicopters and 2 critical care ambulances. Our system provides healthcare in 45 counties in Pennsylvania ranging from rural to semi-urban areas with small community hospitals to large 500 bed hospitals with Level 1, 2 and 4 Trauma Centers. Since 2019, Geisinger Life Flight has carried blood: 2 units Group O positive Red Blood Cells (RBC) from 2019; 1 unit of Low Titer Group O Whole Blood (LTOWB) and 1 unit O Positive RBCs in 2022; and in 2025, 3 units of LTOWB. Over 440 patients have received lifesaving transfusions, over 550 units of RBC and WB over this period.
Study
Design/Methods: A retrospective review of the use of blood products by Life Flight from the beginning of the prehospital transfusion program in 2019 through the present. Source data includes blood bank logs, blood lab information system, and electronic health record.
Results/Findings: The quality program includes statistics for utilization and waste for all LF bases. Overall LF transfusions range from 1 to 32 units/month, with < 1% waste overall. Helicopter bases averaged 12 -20 units/year with ambulances transfusing 5 -10 units/year. 85% of all patients came to our largest hospital. Male patients outnumbered female patients 2:1 with similar average ages 53 for males, 52 for females. The youngest patients transfused during transport were infants < 3 months of age. Over half the females transfused (57%) were >50. Essentially all patients, including females under 50 were transfused with Rh(D) positive RBC or WB per protocol. The ABO/RhD profile of eventually typed patients included 38% O+, 41% A+, 3% B+, 4%AB+, 8% O-, 4%A-, 1% B- and 1% AB-. The patient's type was unknown or indeterminate 38% of the time. Among patients arrived to hospital 18% go on to active Massive Transfusion Protocol. LF Crew return Unit Transfusion Tags and Emergency Release Authorization forms as they obtain replacement units for the cooler. The transfusion tags are scanned to the patient's chart and the patient's history file updated to document the Group O +/- transfusions for ABO/Rh typing interpretations. One instance of a hemolytic transfusion reaction was noted with a patient with an Anti K allo-antibody who received WB on transport that was K+. Conclusions: Providing life saving benefits of transfusion to patients in critical need during transport increases the patient's chance for survival. Our large rural healthcare system has methodically developed policies to support the program with good communication between Life Flight teams and Transfusion Medicine Staff. Proactive quality programs monitoring utilization, waste and blood administration documentation as well as validations of transport coolers are crucial. All teams must take part in the responsibility to ensure a safe, effective transfusion every time.
