[Out-of-hospital blood transfusion by emergency medical services]

The indications for out-of-hospital blood transfusion by emergency medical services (EMS) are relatively rare (0.2 to 1% of interventions). The guidelines and the law about transfusion seem to be a hindrance for out-of-hospital blood transfusion. In prehospital settings, the main concern is the quick supply of blood products, while for interhospital transports the priority is to ensure haemovigilance, thanks to transfusion records. Blood transfusion into mobile intensive care units have to be conform with rules of good practice and guidelines, but it is necessary to consider the specific sanitary conditions in prehospital emergency medicine, which often cause a delay to perform it and this delay must be known by emergency physicians. The writing of a blood transfusion protocol, established in partnership with EMS and haemovigilance centres, should facilitate the set-up of this treatment. This protocol is the guarantor of a safe and effective use of this procedure. The first treatment of hemorrhagic shock is to stop the bleeding. The interest of out-of-hospital blood transfusion is to facilitate and to secure the arrival of patients in operating rooms for an etiological treatment. Thus it is justified when there are significant delays for extraction and/or for transport of patients, or in interhospital transport when transfusion cannot be delayed or interrupted during transfer. It is an exceptional procedure that requires a regular updating of protocols and a regular training of staffs in order to remain safe and effective.