By EMS1 Staff
SAN FRANCISCO — Leading experts in trauma and critical care surgery convened at a news conference at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California, Oct 21, 2024, to discuss the lifesaving potential of making prehospital blood widely available on ambulances across the U.S.
Uncontrolled bleeding is a leading cause of preventable death for people of all ages.
Though some EMS agencies have reported success with prehospital blood implementation, still, few carry any blood component, let alone whole blood, in their ambulances.
|More: Insider analysis: Colorado Springs leads the charge in whole blood transfusion.
The city’s EMS system has saved one life saved for every 3 days of the program, showing promising results.
At the ACS Clinical Congress, experts discussed the benefits and barriers to prehospital whole blood implementation at the national and local levels, progress made to date, solutions to access problems, and success stories that demonstrate the value of prehospital whole blood.
Following are key takeaways from the discussion.
Key takeaways
Prehospital blood saves lives. The data is clear – pre-hospital administration of blood can save thousands of lives annually. Despite this, only 1-2% of EMS units in the U.S. currently carry blood, limiting access to this lifesaving intervention.
“Prehospital blood saves lives. The numbers are staggering.” — John B. Holcomb, MD, FACS, professor, Division of Trauma & Acute Care Surgery, UAB Heersink School of Medicine
Barriers to access. The two main obstacles to wider adoption are state regulations preventing EMS personnel from administering blood and the lack of reimbursement models for this life-saving intervention.
“EMS professionals are ready. We need to take down some of the barriers they are facing.” — Peter E. Fischer, MD, FACS, associate professor of surgery, University of Tennessee Health Science Center in Memphis
Rural disparities. Rural areas, which account for 50% of motor vehicle crashes, face higher mortality rates due to the time it takes to reach trauma centers. Pre-hospital blood could dramatically improve outcomes.
“The disparity here is really what you have to focus on ... 50% of all motor vehicle crashes occur in a rural area, not an urban area ... When it comes to transfer time is over double in a rural setting, and most people would argue it’s probably tripled or quadruple ... And if we talk about a majority of 30-40% of trauma patients are found alive, but then die, potentially in an MVC, you can really see that that potential intervene is immediately important.” — Michael Person, MD, FACS, associate professor of surgery, University of South Dakota Sanford School of Medicine
Military lessons. The military’s experience with blood administration in combat settings has shown a significant improvement in survival rates. This approach can inform and guide civilian EMS practices.
“We had some barriers to implementation of prehospital blood, but once we were able to implement it … moving that capability closer to the point of injury has made a huge impact on lives saved on the battlefield.” — Jennifer Gurney, MD, FACS, COL U.S. Army, chief, Department of Defense Joint Trauma System
Advocacy and funding. Legislative advocacy is critical. The Centers for Medicare & Medicaid Services (CMS) need additional funding to cover EMS interventions, including blood transfusions, to ensure equitable access across the country.
“Congress needs to add money to CMS’s budget, uh, so that they can pay, reimburse, and that’s just the way healthcare works in, in the United States ... and once that happens, then private insurance will follow. — Dr. Holcomb
Action steps to further prehospital whole blood adoption
The panelists offered the following recommendations for furthering prehospital whole blood adoption:
- Increase training and remove regulatory barriers. States must revise their scope-of-practice rules to allow EMS providers to administer blood in the field. Training programs should be expanded to ensure EMS personnel are equipped to safely administer blood.
- Advocate for reimbursement changes. EMS agencies must push for changes in reimbursement models, transitioning from a transport-based to an intervention-based system. This shift will make it financially viable for EMS providers to carry and administer blood.
- Expand blood supply chain logistics. A coordinated effort between blood banks, hospitals and EMS systems is required to ensure blood products are available in rural and underserved areas. Developing a national strategy to manage blood supplies for EMS is essential.
- Engage the public. Public awareness campaigns can help raise the profile of this issue. Encourage individuals to donate blood and advocate for local EMS agencies to carry blood products.
- Leverage military-civilian partnerships. Civilian EMS agencies should adopt best practices from military systems, including the use of whole blood and forward positioning of blood products, to improve trauma survival rates.
The evidence is undeniable – pre-hospital blood administration can save lives, but it requires systemic changes. By removing regulatory barriers, advocating for appropriate funding and adopting proven military strategies, the EMS community can take a significant step toward reducing preventable trauma deaths across the country.
Watch the full discussion here.
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