Objective: In this article, we describe how we developed and validated key performance indicators (KPIs) for pre-hospital blood transfusion and offer suggestions for other organisations wishing to develop performance metrics.Background: KPIs are metrics that compare actual care against an ideal structure, process or outcome standard. An increasing number of UK-based pre-hospital critical care services now carry blood components to enable pre-hospital blood transfusion.Methods: A working group of pre-hospital physicians and paramedics was formed to create and validate performance indicators that reflected a high-quality pre-hospital transfusion. This was performed by literature searching and reviewing consensus documents that guide the best practice and then adjusting the indicators as the process evolved. Results: Throughout the year, the performance against the domains was monitored monthly and outputs communicated within the clinical staff of the organisation; at the end of the year, the domains were amended. The final list of performance indicators was as follows: (a) rationale for transfusion documented in the notes; (b) rationale for transfusion in line with Thames Valley Air Ambulance blood transfusion guideline; (c) aggressive management of hypothermia; (d) tranexamic acid administered within an hour of injury; (e) evidence of bleeding in hospital; (f) monitoring of adverse effects of blood transfusion; (g) overall-was the use of blood justified; and (h) no units wasted this month. Conclusions:This study has shown that it is feasible to devise and implement clinical performance indicators for pre-hospital blood transfusion and that their use has increased the focus on this important area.

The Crew Exploration Vehicle (CEV) Parachute Assembly System (CPAS) project is executing a program to qualify a parachute system for a next generation human spacecraft. Part of the qualification process involves predicting parachute riser tension during system descent with flight simulations. Human rating the CPAS hardware requires a high degree of confidence in the simulation models used to predict parachute loads. However, uncertainty exists in the heritage added mass models used for loads predictions due to a lack of supporting documentation and data. Even though CPAS anchors flight simulation loads predictions to flight tests, extrapolation of these models outside the test regime carries the risk of producing non-bounding loads. A set of equations based on empirically derived functions of skirt radius is recommended as the simplest and most viable method to test and derive an enhanced added mass model for an inflating parachute. This will increase confidence in the capability to predict parachute loads. The selected equations are based on those published in "A Simplified Dynamic Model of Parachute Inflation" by Dean Wolf. An Ames 80x120 wind tunnel test campaign is recommended to acquire the reefing line tension and canopy photogrammetric data needed to quantify the terms in the Wolf equations and reduce uncertainties in parachute loads predictions. Once the campaign is completed, the Wolf equations can be used to predict loads in a typical CPAS Drogue Flight test. Comprehensive descriptions of added mass test techniques from the Apollo Era to the current CPAS project are included for reference.

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