How we implement a prehospital transfusion program.

Abstract

Background: Prehospital blood transfusions are necessary in certain situations that involve significant bleeding to prevent fatality.

Study design and methods: Members of the AABB Donor and Blood Component Management Prehospital working group collaborated to provide a consensus review of best practices in the implementation of a prehospital transfusion program.

Results: Several logistic paradigms exist in terms of how blood products are provided to emergency medical services (EMS). Each paradigm has pros and cons and should be adopted according to the specific environmental and operational needs of the states, regions, and agencies they serve. Low titer group O whole blood (LTOWB) has been successfully used in prehospital programs, but blood components such as packed red blood cells (pRBCs) and liquid plasma may also be used. All blood products carried by EMS must be transported and stored according to the same regulatory requirements set by the United States Food and Drug Administration. Processes must be in place to minimize wastage of blood products carried by EMS due to product expiration to preserve this limited resource. Barriers to the implementation of a prehospital transfusion program include scope of practice limitations, program costs, blood product reimbursement, cost of wastage, and collaboration between prehospital agencies, blood suppliers, and hospital transfusion services.

Discussion: Program implementation requires significant collaboration among different business entities with a carefully written and executed agreement. Despite the barriers, prehospital transfusion programs are worthy endeavors with the potential to save lives.