BACKGROUND. Administration of blood in the pre-hospital environment is becoming more feasible, particularly in helicopter emergency medical services (HEMS) during primary response and critical care transfers of major trauma patients. The main challenge in this environment is maintaining a suitable thermal environment for blood transport during missions that may last several hours. OBJECTIVE. To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood. METHODS. A commercially available cooler box and ice packs were used to simulate a blood transport environment during HEMS missions over three summer and three winter months. In-box temperature was monitored using an electronic thermometer and data logger. RESULTS. Temperature data were recorded during 146 missions with a mean duration of 02:01:35 (95% confidence interval 01:46:25 - 02:16:46). A total of 344 temperature observations were done in the summer months and 384 in the winter months. All mean temperatures recorded in the cooler box were within the required 1 - 6°C range; however, of the total temperature observations recorded, 30% (102/344) during summer were >6°C while 8% (32/384) during winter were >6°C and 15% (59/384) were
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