The Problem
Exsanguination remains the leading cause of preventable deaths among victims of trauma with nearly half of these patients dying in the prehospital setting. Prehospital blood resuscitation is also clinically indicated for selected patients who hemorrhage from medical conditions (e.g. post-partum hemorrhage, abdominal bleeds). Individuals requiring critical care in the field in many locations in the US do not have access to prehospital blood transfusions due to reimbursement policies and scope of practice limitations.
The Coalition, led by a steering committee, is building a multi-disciplinary, industry-wide collaborative initiative to advance five pillars of focused activity to promote prehospital blood transfusion programs:
- Reimbursement and Advocacy: For blood products transfused in the prehospital setting.
- Scope of Practice and Data: EMS scope-of-practice modifications to include paramedic initiated transfusions in states where it currently is not allowed and enhancing appropriate EMS clinical documentation
- Strategic Preparedness: For major mass casualty incidents and other national emergencies.
- Outreach, Education and Research: Outreach and education, including regulatory, protocols, and best practices for programs based on experiences of agencies currently conducting programs; highlighting appropriate research publications
Studies have shown that the use of blood products prior to arrival at the hospital significantly improves both military and civilian patient survival. Data from randomized controlled trials also indicate that delay in providing blood products increases the risk of mortality in patients with severe traumatic bleeding. In fact, a recent study demonstrated that for every 1-minute delay in prehospital resuscitation there was a 2% increase in the odds of 30-day mortality.
The use of prehospital blood products is widespread within the deployed Department of Defense trauma system and has been proven lifesaving. However, a limited number of civilian prehospital systems have implemented prehospital transfusion programs.
These programs in various states have shown that implementation of prehospital transfusion programs can be safe and successful.
In fact, a recent position statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians recommended that all patients with signs of hemorrhagic shock should receive blood products whenever available.
In addition, the International Association of EMS Chiefs have also released a position statement.
Our Strategy
A growing number of ground and air medical EMS programs have successfully initiated blood programs in recent years, but more needs to be done to ensure patients in the U.S. who need prehospital transfusion are able to receive it, regardless of where they live.
The Prehospital Blood Transfusion Initiative Coalition is building a multi-disciplinary, industry-wide collaborative initiative to advance alternatives for reimbursement mechanism approaches and appropriate scope-of-practice modifications to accommodate blood transfusion by ground and air EMS systems anywhere in the United States. This includes development of a reimbursement proposal for the Centers for Medicare and Medicaid Services (CMS) and prehospital blood policy recommendations to Congress and to individual states addressing inconsistencies in scope-of-practice standards.
The Coalition will also address U.S. strategic preparedness as it pertains to blood availability in the field for everyday trauma and mass casualty events, as well as implement an educational support program for EMS related to prehospital transfusions.