Show Notes

Core EM Modular CME Course

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Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
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What is prehospital blood transfusion

Administration of blood products in the field prior to hospital arrival
Aimed at patients in hemorrhagic shock

Why this matters

Traditional US prehospital resuscitation relied on crystalloid
ED and trauma care now prioritize early blood
Hemorrhage occurs before hospital arrival
Delays to definitive hemorrhage control are common
Earlier blood may improve survival

Supporting rationale

ATLS and trauma paradigms emphasize blood over fluid
National organizations support prehospital blood when feasible
EMS already manages high risk, time sensitive interventions

Evidence overview

Data are mixed and evolving
- COMBAT: no benefit
- PAMPer: mortality benefit
- RePHILL: no clear benefit
Signal toward benefit when transport time exceeds ~20 minutes
Urban systems still experience long delays due to traffic and geography
LA County median time to in hospital transfusion ~35 minutes

LA County program

~2 years of planning before launch
Pilot began April 1
Partnerships:
- LA County Fire
- Compton Fire
- Local trauma centers
- San Diego Blood Bank
14 units of blood circulating in the field
Blood rotated back 14 days before expiration
Ultimately used at Harbor UCLA
Continuous temperature and safety monitoring

Indications used in LA County

Focused rollout
Trauma related hemorrhagic shock
Postpartum hemorrhage

Physiologic criteria:

SBP < 70
Or HR > 110 with SBP < 90
Shock index ≥ 1.2
Witnessed traumatic cardiac arrest

Products:

One unit whole blood preferred
Two units PRBCs if whole blood unavailable

Early experience

~28 patients transfused at time of discussion
Eva...

Episode 217: Prehospital Blood Transfusion