Podcasts · Core EM - Emergency Medicine Podcast
Episode 217: Prehospital Blood Transfusion
· Episode 217
Episode Episode 217: Prehospital Blood Transfusion
We discuss the shift to prehospital blood to treat shock sooner.
Hosts: Nichole Bosson, MD, MPH, FACEP Avir Mitra, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Prehospital_Transfusion.mp3
Download Leave a Comment Tags: EMS, Prehospital Care, Trauma
Show Notes Core EM Modular CME Course
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Click Here to Register and Begin Module 1 What is prehospital blood transfusion
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Administration of blood products in the field prior to hospital arrival
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Aimed at patients in hemorrhagic shock
Why this matters
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Traditional US prehospital resuscitation relied on crystalloid
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ED and trauma care now prioritize early blood
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Hemorrhage occurs before hospital arrival
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Delays to definitive hemorrhage control are common
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Earlier blood may improve survival
Supporting rationale
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ATLS and trauma paradigms emphasize blood over fluid
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National organizations support prehospital blood when feasible
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EMS already manages high risk, time sensitive interventions
Evidence overview
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Data are mixed and evolving
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COMBAT: no benefit
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PAMPer: mortality benefit
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RePHILL: no clear benefit
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Signal toward benefit when transport time exceeds ~20 minutes
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Urban systems still experience long delays due to traffic and geography
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LA County median time to in hospital transfusion ~35 minutes
LA County program
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~2 years of planning before launch
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Pilot began April 1
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Partnerships:
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LA County Fire
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Compton Fire
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Local trauma centers
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San Diego Blood Bank
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14 units of blood circulating in the field
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Blood rotated back 14 days before expiration
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Ultimately used at Harbor UCLA
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Continuous temperature and safety monitoring
Indications used in LA County
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Focused rollout
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Trauma related hemorrhagic shock
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Postpartum hemorrhage
Physiologic criteria:
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SBP < 70
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Or HR > 110 with SBP < 90
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Shock index ≥ 1.2
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Witnessed traumatic cardiac arrest
Products:
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One unit whole blood preferred
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Two units PRBCs if whole blood unavailable
Early experience
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~28 patients transfused at time of discussion
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Evaluating:
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Indications
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Protocol adherence
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Time to transfusion
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Early outcomes
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Too early for outcome conclusions
California collaboration
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Multiple active programs:
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Riverside (Corona Fire)
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LA County
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Ventura County
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Additional programs planned:
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Sacramento
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San Bernardino
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Programs meet monthly as CalDROP
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Focus on shared learning and operational optimization
Barriers and concerns
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Trauma surgeon concerns about blood supply
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Need for system wide buy in
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Community engagement
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Patients who may decline transfusion
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Women of childbearing age and alloimmunization risk
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Risk of HDFN is extremely low
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Clear communication with receiving hospitals is essential
Future direction
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Rapid national expansion expected
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Greatest benefit likely where transport delays exist
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Prehospital Blood Transfusion Coalition active nationally
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Major unresolved issue: reimbursement
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Currently funded largely by fire departments
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Sustainability depends on policy and payment reform
Take-Home Points
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Hemorrhagic shock is best treated with blood, not crystalloid
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Prehospital transfusion may benefit patients with prolonged transport times
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Implementation requires strong partnerships with blood banks and trauma centers
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Early data are promising, but patient selection remains critical
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National collaboration is key…
Links in the notes 7
- https://coreem.net/podcast/episode-217-prehospital-blood-transfusion/
- https://media.blubrry.com/coreem/content.blubrry.com/coreem/Prehospital_Transfusion.mp3
- https://coreem.net/podcast/episode-217-prehospital-blood-transfusion/#comments
- https://coreem.net/tag/ems/
- https://coreem.net/tag/prehospital-care/
- https://coreem.net/tag/trauma/
- https://www.highmarksce.com/nyumc/Planners/viewActivity?style=2&preview=true&plannerID=3560#CourseDetails
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