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The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results

Published online by Cambridge University Press:  26 June 2023

Charles Coyle ,
Tony Zitek Open the ORCID record for Tony Zitek [Opens in a new window] ,
Paul E. Pepe ,
Madonna Stotsenburg ,
Kenneth A. Scheppke ,
Peter Antevy ,
Richard Giroux  and
David A. Farcy
Charles Coyle
Affiliation:
Palm Beach County Fire Rescue, West Palm Beach, Florida USA
Tony Zitek*
Affiliation:
Department of Emergency Medicine, Mt. Sinai Medical Center, Miami Beach, Florida USA
Paul E. Pepe
Affiliation:
Palm Beach County Fire Rescue, West Palm Beach, Florida USA
Madonna Stotsenburg
Affiliation:
Department of Trauma Services and Emergency Management, St. Mary’s Medical Center, West Palm Beach, Florida USA
Kenneth A. Scheppke
Affiliation:
Palm Beach County Fire Rescue, West Palm Beach, Florida USA
Peter Antevy
Affiliation:
Palm Beach County Fire Rescue, West Palm Beach, Florida USA
Richard Giroux
Affiliation:
Palm Beach County Fire Rescue, West Palm Beach, Florida USA
David A. Farcy
Affiliation:
Palm Beach County Fire Rescue, West Palm Beach, Florida USA Department of Emergency Medicine, Mt. Sinai Medical Center, Miami Beach, Florida USA
*
Correspondence: Tony Zitek, MD Department of Emergency Medicine Mount Sinai Medical Center 4300 Alton Rd Miami Beach, Florida 33140 USA E-mail: zitek10@gmail.com
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Abstract

Introduction:

In far-forward combat situations, the military challenged dogma by using whole blood transfusions (WBTs) rather than component-based therapy. More recently, some trauma centers have initiated WBT programs with reported success. There are a few Emergency Medical Service (EMS) systems that are using WBTs, but the vast majority are not. Given the increasing data supporting the use of WBTs in the prehospital setting, more EMS systems are likely to consider or begin WBT programs in the future.

Objective:

A prehospital WBT program was recently implemented in Palm Beach County, Florida (USA). This report will discuss how the program was implemented, the obstacles faced, and the initial results.

Methods:

This report describes the process by which a prehospital WBT program was implemented by Palm Beach County Fire Rescue and the outcomes of the initial case series of patients who received WBTs in this system. Efforts to initiate the prehospital WBT program for this system began in 2018. The program had several obstacles to overcome, with one of the major obstacles being the legal team’s perception of potential liability that might occur with a new prehospital blood transfusion program. This obstacle was overcome through education of local elected officials regarding the latest scientific evidence in favor of prehospital WBTs with potential life-saving benefits to the community. After moving past this hurdle, the program went live on July 6, 2022. The initial indications for transfusion of cold-stored, low titer, leukoreduced O+ whole blood in the prehospital setting included traumatic injuries with systolic blood pressure (SBP) < 70mmHg or SBP < 90mmHg plus heart rate (HR) > 110 beats per minute.

Findings:

From the date of onset through December 31, 2022, Palm Beach County Fire Rescue transported a total of 881 trauma activation patients, with 20 (2.3%) receiving WBT. Overall, nine (45%) of the patients who had received WBTs so far remain alive. No adverse events related to transfusion were identified following WBT administration. A total of 18 units of whole blood reached expiration of the unit’s shelf life prior to transfusion.

Conclusion:

Despite a number of logistical and legal obstacles, Palm Beach County Fire Rescue successfully implemented a prehospital WBT program. Other EMS systems that are considering a prehospital WBT program should review the included protocol and the barriers to implementation that were faced.

Keywords

Emergency Medical Services (EMS)prehospitaltransfusionstraumawhole blood
Type
Research Report
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 4 , August 2023 , pp. 513 - 517
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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