The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

Abstract

Background Prehospital management of the traumatically injured patient has evolved significantly since the organization of emergency medical services across the United States in the 1970s. Initially focusing on the utilization of crystalloid solutions to restore shed blood volume, robust military and civilian trauma experiences led to a modern day shift towards balanced blood component and ultimately whole blood use for immediate volume replacement. In addition, prehospital transfusion or remote damage control resuscitation (RDRC) has been widely adopted. This has led to point of injury resuscitation using blood products both in the United States and abroad. Objectives This article will review the evolution of civilian and military prehospital resuscitation as well as the current practice of prehospital whole blood transfusion in the civilian trauma population in the United States. Additionally, we will provide an overview of our regional trauma system's use of whole blood with focus on the programme infrastructure, donor programme, product rotation schedule and logistical challenges. Finally, we provide three case report examples of the effective use of whole blood in our civilian emergency medical services (EMS) programs.

How do I implement a whole blood–based blood preparedness program in a small rural hospital?

“…The strategy will depend on the distance to the blood supplier, the capabilities in blood collection and processing on site, and the availability of local blood donors. 22,[24][25][26] When seen from a preparedness perspective, whole blood collection and production should be performed locally. This has the shortest response time and will ensure availability if the rural community is isolated, as may happen during extreme weather conditions, war, or natural disasters.…”

“…In addition to the regular blood donor population, establishment of a prescreened emergency donor pool among hospital and emergency medical service/fire/ police personnel should be considered. 26 The emergency donor selection plan should include considerations of potential relaxations of donor selection requirements that do not compromise donor or patient safety. 27 Emergency donation procedures should include guidance for blood collection if standard donor equipment such as donor beds and scales are not available.…”

From battlefront to homefront: creation of a civilian walking blood bank

“…The Southwest Texas Regional Advisory Committee (STRAC) provides regional trauma management services for Trauma Service Area P, which is a 22‐county, 26,000‐square‐mile area and includes 70 emergency medical service (EMS) agencies, two Level 1 trauma centers, three Level 3 trauma centers, and 25 Level 4 trauma centers. In 2018, STRAC, The University of Texas Health Science Center at San Antonio, and South Texas Blood & Tissue Center (STBTC) partnered to create a comprehensive prehospital WB program that includes availability for selected ground and helicopter EMS units and trauma centers of all levels . In the prehospital setting, WB is transported in carefully chosen and validated storage containers that meet current standard blood bank parameters.…”

“…Newly packaged units are then redistributed to the low‐use sites to maintain appropriate levels. This system has minimized the WB waste in the STRAC region to as low as 2% …”

“…Transfusion criteria were developed by all parties involved in the STRAC prehospital WB program. The criteria consist of a set of injury and physiologic parameters that have been chosen to maximize identification of patients who will benefit from transfusion while minimizing the number of unnecessary transfusions …”