How do we implement a prehospital whole blood administration program for shock trauma patients on a statewide basis?

Abstract

Background: Since bleeding is a major cause of early mortality in trauma, there is continued interest in providing transfusion support as early as possible to trauma patients. Various approaches have been taken to accomplish this, including the rapid provision of blood products upon arrival at the hospital, as well as a variety of prehospital approaches. However, implementing prehospital blood availability statewide for use in all populations has been limited.

Study design and methods: The program described for prehospital transfusion identifies a direct partnership between state EMS providers and the local blood center. Predictive modeling is compared to early outcome data of the first 100 patients who received whole blood from this program. Additional discussion contains key elements of the program, including planning, validation, and implementation.

Results: Between May 2023 and July 2024, an average of 11 prehospital whole blood units were transfused per month against the projected average of 10-16 units administered per month, with the median time to transfusion of 29.2 min. The leading reason for blood administration was due to blunt trauma. Of the patients who were not in prehospital cardiac arrest prior to paramedic arrival or excluded for other reasons, approximately 95% survived to hospital discharge.

Discussion: Implementation of prehospital whole blood across the state has demonstrated effectiveness early within the first year of the program. Continued process improvements will be implemented with statewide ground paramedic agency utilization of whole blood as well as expansion into aviation divisions for more expedient whole blood administration times.