Service evaluation of pre-hospital lyophilised plasma delivery by a hazardous area response team: the HART PLAsMa project

Introduction: Major haemorrhage is a leading cause of preventable death following major trauma. In the United Kingdom (UK), pre-hospital blood products are typically delivered by helicopter emergency medical services, enhanced and critical care teams (ECCTs) and physician-led models; however, these teams may be unable to access the highest-risk areas of complex or major incidents. The Manchester Arena Inquiry recommended exploring whether hazardous area response team (HART) paramedics could deliver lyophilised plasma (Lyoplas) to address this gap. This study describes the implementation and service evaluation of a HART-delivered Lyoplas capability. Methods: This prospective service evaluation was conducted over 12 months, from 1 April 2023 to 31 March 2024, within a UK ambulance service. Sixty-one HART paramedics were trained to deliver Lyoplas under a major haemorrhage protocol (MHP) requiring critical care medical advisor authorisation. Outcome measures included frequency and context of Lyoplas use. Process measures assessed adherence to the MHP and balancing measures examined effects on routine care, safety events and resource use. Cases were independently audited using anonymised clinical records against predefined criteria. Results: Twenty MHP activations occurred; 18 were authorised and Lyoplas was administered in 17 cases. HART initiated transfusion in 11 incidents and supported ECCT transfusion in six, delivering a total of 30 units. Authorisation was sought in 100% of cases and indications were appropriate in 94%. Correct unit dosing occurred in 88%, and calcium chloride supplementation compliance was 81%, with deviations largely clinically justified. Delivery of standard major-haemorrhage interventions was preserved. No transfusion reactions or safety-related incidents were identified. Lyoplas wastage was low (3.1%), and annual running costs were modest. Conclusion: Lyoplas was successfully implemented within HART practice, with high protocol adherence and no identified safety concerns. No major incidents occurred during the evaluation period; therefore, findings are limited to routine operational use. However, this service evaluation indicates that a pre-hospital blood-product capability can be integrated into HART operations and may help address the care gap identified by the Manchester Arena Inquiry. Further multi-site evaluation, including in major incident contexts, is warranted.