The Untapped Lifesaving Potential of Prehospital Blood Transfusion

Saving lives on U.S. roads and highways has long been core to NHTSA’s mission. It gained renewed energy with the passing of the Bipartisan Infrastructure Law, which provided once-in-a-generation funding for projects and programs to reduce death and serious injury from motor vehicle crashes (MVC). 

And while no single solution can eliminate the thousands of lives lost in vehicle collisions, there’s good reason to believe that prehospital blood transfusion to crash victims by EMS clinicians could save many who’d otherwise die. 

So what is prehospital blood transfusion? First, you already know that many people in a MVC experience severe external and/or internal bleeding. In fact, exsanguination remains the leading cause of preventable death among victims of trauma, with nearly half of trauma patients dying before they reach the hospital. You may also know that 42% of people in a crash who later died were still alive when first responders arrived. Simply put, delivering blood at the scene could save many more lives. Too often, crash victims cannot wait to arrive at a hospital to receive the blood they desperately need. A 2023 study showed that for every one-minute delay in prehospital resuscitation, the odds of 30-day mortality increased by 2%.

There’s little question that delivering blood (most programs use low-titer O-positive whole blood) at the scene saves lives and is safe to use. Numerous studies point to this. One trial of nearly 1,400 trauma patients receiving emergency blood products found that those who received whole blood had a four-fold increased survival rate and were also less likely to need more blood later. A 14-center prospective observational study of 1,623 trauma patients who got whole blood or blood component therapy (such as plasma, platelets or red blood cells) found that those who got whole blood were 48% less likely to die than those who got blood component therapy.

Few EMS organizations, though, have prehospital blood products on hand. The most recent figures estimate that about 2% to 3% of all EMS agencies in the U.S. have a prehospital blood program in place, though this is changing quickly, says John Holcomb, M.D., FACS, Col. (Ret.), U.S. Army, and Professor of Surgery at the University of Alabama at Birmingham and the Uniformed Services University in Bethesda, Maryland. A leading researcher in prehospital blood and military trauma systems, Dr. Holcomb says he’s seen a roughly 30% increase in prehospital blood programs in recent months. It is, he says, “starting to catch fire.” Among other considerations, putting a program in place requires determining how to store the blood products; criteria for prehospital transfusion; training and credentialing processes; and documentation of the transfusion and handover from EMS to hospital staff. 

To learn more about prehospital blood transfusion and developing a program at your organization, visit the Prehospital Blood Transfusion Initiative Coalition.