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All injured patients given prehospital blood transfusions by flight nurses of the 'Lifeflight' Helicopter Emergency Medical Service (HEMS) programme based at Emanuel Hospital, Portland, Oregon, USA, between 1985 and 1991 were included in the study. Of the 112 patients, there were no documented adverse reactions directly related to the administration of O-negative packed red cells, although one patient suffered transient shortness of breath. It is a safe and practical prehospital procedure. Further studies are required to assess the advantages over other fluids.

A Helicopter Emergency Medical Service (HEMS) has been introduced to improve trauma care in the Southeast of England. The majority of the workload comes from the area bounded by the M25 ring road. In 1989 a Dauphin 365N helicopter equipped for pre-hospital primary rescue and emergency inter-hospital secondary transfer was certified by the Civil Aviation Authority. The helicopter commenced carrying patients with a paramedic and a doctor on board early in 1990. In September 1990 this service was further improved by the opening of a helipad at the Royal London Hospital and a designated HEMS desk at London Ambulance Service central control. Eighty-four patients were transported in primary rescue missions and 107 as emergency transfers in 1990.

All roadside procedures carried out by doctors of the Royal London Hospital Helicopter Emergency Medical Service were recorded. Of 100 injured patients treated consecutively, 68 patients required 73 treatments or procedures that were beyond the current training of the ambulance paramedic in the United Kingdom. Doctors are therefore an essential part of HEMS operations and allow earlier live-saving medical intervention in the prehospital phase of care.