Evaluating reimbursement for prehospital blood transfusions: A nationwide survey

Prehospital blood transfusion improves survival among patients in hemorrhagic shock but remains underutilized, in part due to financial barriers. However, little is known about how prehospital blood transfusion programs are reimbursed. The objective of this study is to determine the percentage of prehospital blood transfusion programs that receive reimbursement, the percentage of patients receiving blood who were public health insurance-eligible (pediatric and geriatric patients), and the most common reason for blood transfusions in these populations.

An electronic survey was administered to Emergency Medical Services agencies with an active blood transfusion program in 2024.

Of the 53/150 agencies who responded to the survey, only 6 (11%) agencies reported receiving reimbursement for prehospital blood transfusions. However, 53 (100%) agencies reported transfusing geriatric patients, and 43 (81%) agencies reported transfusing pediatric patients, both groups that are eligible for public health insurance. Medical emergencies were the most common indications for transfusion in geriatric patients, whereas blunt and/or penetrating injuries were the primary indications for transfusion in pediatric patients. For most agencies, geriatric and pediatric patients were frequent recipients of blood transfusions, each comprising up to 50% of the total transfusions administered.

Many patients who receive prehospital blood transfusion are public health insurance-eligible. Health policy changes to enable government reimbursement for prehospital blood transfusions would provide critical financial support for this life-saving intervention.