spoon feed

PODCAST: Prehospital Blood Transfusion

Listen Later
What is prehospital blood transfusion

  • Administration of blood products in the field prior to hospital arrival

  • Aimed at patients in hemorrhagic shock

    Why this matters

    • Traditional US prehospital resuscitation relied on crystalloid

    • ED and trauma care now prioritize early blood

    • Hemorrhage occurs before hospital arrival

    • Delays to definitive hemorrhage control are common

    • Earlier blood may improve survival

      Supporting rationale

      • ATLS and trauma paradigms emphasize blood over fluid

      • National organizations support prehospital blood when feasible

      • EMS already manages high risk, time sensitive interventions

        Evidence overview

        • Data are mixed and evolving

          • COMBAT: no benefit

          • PAMPer: mortality benefit

          • RePHILL: no clear benefit

          • Signal toward benefit when transport time exceeds ~20 minutes

          • Urban systems still experience long delays due to traffic and geography

          • LA County median time to in hospital transfusion ~35 minutes

            LA County program

            • ~2 years of planning before launch

            • Pilot began April 1

            • Partnerships:

              • LA County Fire

              • Compton Fire

              • Local trauma centers

              • San Diego Blood Bank

              • 14 units of blood circulating in the field

              • Blood rotated back 14 days before expiration

              • Ultimately used at Harbor UCLA

              • Continuous temperature and safety monitoring

                Indications used in LA County

                • Focused rollout

                • Trauma related hemorrhagic shock

                • Postpartum hemorrhage

                  Physiologic criteria:

                  • SBP < 70

                  • Or HR > 110 with SBP < 90

                  • Shock index ≥ 1.2

                  • Witnessed traumatic cardiac arrest

                    Products:

                    • One unit whole blood preferred

                    • Two units PRBCs if whole blood unavailable

                      Early experience

                      • ~28 patients transfused at time of discussion

                      • Evaluating:

                        • Indications

                        • Protocol adherence

                        • Time to transfusion

                        • Early outcomes

                        • Too early for outcome conclusions

                          California collaboration

                          • Multiple active programs:

                            • Riverside (Corona Fire)

                            • LA County

                            • Ventura County

                            • Additional programs planned:

                              • Sacramento

                              • San Bernardino

                              • Programs meet monthly as CalDROP

                              • Focus on shared learning and operational optimization

                                Barriers and concerns

                                • Trauma surgeon concerns about blood supply

                                • Need for system wide buy in

                                • Community engagement

                                • Patients who may decline transfusion

                                • Women of childbearing age and alloimmunization risk

                                • Risk of HDFN is extremely low

                                • Clear communication with receiving hospitals is essential

                                  Future direction

                                  • Rapid national expansion expected

                                  • Greatest benefit likely where transport delays exist

                                  • Prehospital Blood Transfusion Coalition active nationally

                                  • Major unresolved issue: reimbursement

                                  • Currently funded largely by fire departments

                                  • Sustainability depends on policy and payment reform

                                    Take-Home Points

                                    • Hemorrhagic shock is best treated with blood, not crystalloid

                                    • Prehospital transfusion may benefit patients with prolonged transport times

                                    • Implementation requires strong partnerships with blood banks and trauma centers

                                    • Early data are promising, but patient selection remains critical

                                    • National collaboration is key to sustainability and future growth

                                      The post PODCAST: Prehospital Blood Transfusion first appeared on האיגוד הישראלי לרפואה דחופה.

                                      ...more
                                      View all episodesView all episodes
                                      Download on the App Store
                                      spoon feedBy spoon feed