One-Year Retrospective Evaluation of Blood Administration Practices Within LifeFlight Medicine

To define and compare the incidence, patient demographics, tasking characteristics, and clinical features associated with packed red blood cell (PRBC) administration within the LifeFlight Medical Services (LFM) retrieval network during the 2024 calendar year.

A retrospective cohort study examined all LFM missions in 2024 involving PRBC administration. Missions were included when PRBCs were administered by, or at the direction of, an LFM doctor. Primary missions and interfacility transfers (IFT) were analysed and compared with the overall mission cohort. Collected variables included transport platform, indication for transfusion, patient demographics, blood product utilisation, wastage, and compliance with adjunctive therapies.

Among 7791 missions, PRBCs were administered on 226 missions (2.9% of all missions), including 100 primary missions (7.6% of all primary missions) and 126 IFT's (1.9% of all IFT's). A total of 492 units were transfused, with 3.0% wastage. Primary trauma accounted for 59% of transfusions and medical/surgical causes for 41%, most commonly upper gastrointestinal bleeding. Rotary-wing and road-based platforms demonstrated the highest transfusion incidence. No significant age differences were identified between transfused and non-transfused patients. Compliance with blood warming, tranexamic acid, and calcium administration was high at 81%, 83%, and 85%, respectively. Use of O-positive blood in females under 50 years was rare, occurring in 0.3% of primary missions.

PRBC transfusion within LFM is infrequent but essential across all missions. This analysis provides the first comprehensive Australian description of real-world PRBC utilisation across retrieval platforms, supporting transfusion governance, operational planning, and future outcome-focused research within Australia.