Prehospital Blood Transfusion Programs
Severe bleeding is the leading cause of preventable death among trauma patients, including those involved in a motor-vehicle crash. Scientific evidence makes clear that providing blood at the scene—before arrival at the hospital—can save many more lives. For every minute of delay in administering prehospital blood to a trauma patient, mortality increases by 11%.
What Is a Prehospital Blood Transfusion Program?
A prehospital blood transfusion program enables EMS agencies to supply lifesaving blood and/or blood components to trauma patients and anyone else who may need it at the scene of an incident.
Why Establish a Prehospital Blood Transfusion Program?
The benefits of adding prehospital blood transfusion programs in your community can be profound. Both military and civilian scientific research makes clear that many lives could be saved if blood was delivered sooner to those experiencing trauma. In particular, there’s an opportunity to offer lifesaving blood as part of improving post-crash care, one of five parts of a Safe System Approach to eliminating roadway deaths.
A joint position statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians and the National Association of EMS Physicians published in July 2023 in the Annals of Emergency Medicine cites research showing that “prehospital blood product resuscitation has demonstrated greater than predicted survival with a 37% reduction in 30-day mortality among severely injured civilian patients.”
Three Benefits of a Prehospital Blood Transfusion Program
By bringing whole blood transfusions to the point of injury, EMS teams can act faster, stabilize critical patients sooner, and ultimately save more lives.
Improved patient outcomes – Trauma patients who received whole blood in the field were four times more likely to survive than those who did not.
Enhanced EMS capabilities – A prehospital blood transfusion program allows clinicians to more quickly and efficiently stabilize complex trauma patients.
Faster progress toward reducing roadway fatalities – Between 2013 and 2022, fatal traffic crashes increased by 30%. As trauma-related deaths rise, giving emergency responders the ability to administer blood before patients reach the hospital can significantly improve survival rates.
What Does a Prehospital Blood Transfusion Program Look Like?
Around the country, EMS organizations are creating a prehospital blood transfusion program to serve their trauma patients. Some are established in a single agency, while others serve a region, which may increase the number of stakeholders who will support the effort, like 911 centers, which may dispatch prehospital blood resources to an incident.
Use the resources below to better understand how others approach their prehospital blood transfusion program to help find the way that will work best for you. It’s important, too, to understand how your state’s EMS scope of practice may need to change to allow clinicians to administer blood as well as possible related changes to legislation and licensure.
Six Elements of a Prehospital Blood Transfusion Program
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Community, regional and hospital blood banks, hospital administrators, EMS, state/local EMS medical director, trauma/ER personnel and state agencies with jurisdictional authority provide initial and ongoing input and feedback. They can assist in overcoming regulatory, administrative and logistical barriers.
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Across the country, blood is often in short supply, and one crash patient can require as many as 100 units of blood. Working with regional hospitals and blood banks ensures adequate blood products are available to EMS, and agency-based blood drives can also increase supply.
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Vehicles carrying blood products must have blood-administration equipment, fluid warmers and temperature-monitored coolers that maintain appropriate storage conditions.
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Sharing scientific literature supporting the value of prehospital blood transfusion in more trauma patients is critical, as is allocating funds and time to develop a prehospital blood administration training curriculum and paying clinicians salaries to participate in training and ongoing education, evaluation and credentialing.
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Initial and ongoing data analysis on blood usage patterns, patient outcomes, system efficiency, local/state gaps in blood availability and access, inventory levels and transportation infrastructure tracks a prehospital blood transfusion program’s effectiveness.
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These include documented, locally compliant processes and criteria for clinician (paramedic) transfusion of prehospital blood; storage, packaging, transport, and resupply of blood; disposition of unused blood; billing and reimbursement; and patient hand over from EMS to hospital staff.
Resources
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Journal of Emergency Medical Services: Whole Blood Transfusion Launched in Two CO Counties (Colorado) (12/18/2024)
Journal of Emergency Medical Services: CMS Updates the ALS2 Definition to Include Additional Blood Products (11/12/2024)
WDEL.com (Delaware): Whole blood now carried by EMS statewide (11/6/2024)
EMS World: American College of Surgeons: Whole Blood Transfusions Could Save 10,000 Lives Annually (10/22/2024)
Journal of Emergency Medical Services: WV Implements Whole Blood Protocols (9/3/2024)
Boston.com: Whole blood transfusion saves rider after ATV crash in Walpole (7/22/2024)
EMS1.com: Mutual aid delivery of whole blood helps save Okla. worker (Oklahoma) (2/1/2024)
Washington, DC: Mayor Bowser Announces New, Lifesaving Pre-Hospital Blood Transfusion Program (1/25/2024)
EMS1.com: S.D. air-medical EMS now carrying whole blood (South Dakota) (10/2/2023)
Journal of Emergency Medical Services: The Blood, Sweat and Tears Behind San Antonio’s Whole Blood Program (5/13/2022)
Journal of Emergency Medical Services: Austin-Travis County EMS Launches Pilot Program to Carry Whole Blood (Texas) (12/8/2021)
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