Development and Evaluation of a Novel Curriculum for Whole Blood Transfusion by Paramedics in the Prehospital Environment

Resuscitation with low-titer O+ whole blood improves the outcomes of patients with hemorrhagic shock. Recently, some emergency medical services (EMS) agencies have started to carry blood in the field. However, there exists no standardized training program to teach paramedics the fundamentals of blood administration. This study describes one EMS system's experience with implementing a novel, whole blood educational curriculum.

We used Kern's six-step framework to develop a novel curriculum to provide paramedics the requisite knowledge to safely administer blood in the field. The course included an asynchronous component as well as an in-person, skills competency verification. The asynchronous portion was open to any paramedic, but only paramedic supervisors were eligible for the in-person skills check as they are the ones tasked with administering blood in the field. The course was evaluated through survey and performance outcome measurements.

Fifty-three (26.5%) of 200 total paramedics at a combined career and volunteer fire department enrolled in the asynchronous course, and 31 (58.5%) completed the pre- and post-course survey. Of participating paramedic supervisors, 20 of 20 (100%) finished both portions of the course. Survey answers were based on a 5-point Likert scale. We reported results as a mean, with 5 corresponding to "strongly comfortable" or "strongly agree." There was a statistically significant increase in the number of respondents who felt overall comfortable in administering blood from 3.51 to 4.16 (P = 0.003). Additionally, there was an increase in the number of paramedics who reported feeling comfortable performing the procedure of a blood transfusion from 3.11 to 4.13 (P = <0.001). Nearly all participants (30/31) would recommend the course to someone else. In the first three months of carrying blood in the field, there were 12 units of blood transfused and no protocol deviations or safety events.

This study provides a model for the successful creation and implementation of a prehospital blood transfusion educational program using Kern's framework. The curriculum was implemented in a single EMS system with senior paramedics, which may limit generalizability.