Statewide Emergency Medical Services Protocols for Field-Initiated Blood Resuscitation

Area of Science:

• Emergency Medicine
• Transfusion Medicine
• Public Health Policy

Background:

• Prehospital blood transfusion by emergency medical services (EMS) improves trauma patient outcomes.
• Statewide protocols significantly influence the availability and use of prehospital blood products.
• Limited understanding exists regarding current US statewide EMS protocols for field-initiated transfusions.

Purpose of the Study:

• To describe statewide EMS protocols concerning field-initiated prehospital blood and blood product transfusion across the United States.
• To identify variations in protocols regarding indications, product types, and patient-specific considerations.

Main Methods:

• Cross-sectional analysis of publicly available statewide EMS protocols for ground transport by advanced life support (ALS) clinicians.
• Exclusion of protocols for critical care or interfacility transport.
• Standardized data collection tool to compare clinical indications, blood product types, and considerations for pediatric and female patients of childbearing potential.

Main Results:

• 31 states and DC had publicly available protocols; 13 (42%) allowed field-initiated prehospital blood transfusion.
• Protocols showed variability in transfusion indications and administration details.
• All protocols permitted transfusion in trauma; 9 (69%) in medical emergencies. Low titer O whole blood was specified in 3 (23%) protocols. Pediatric transfusion was allowed in 9 (69%) protocols, with special considerations for females in only 4 (31%).

Conclusions:

• Most US statewide EMS protocols do not currently include field-initiated blood transfusion.
• Significant variability exists among the protocols that do permit prehospital transfusion.
• Findings indicate an opportunity to develop more robust, evidence-based guidelines for prehospital blood transfusion to enhance patient care.