Prehospital Trauma Compendium: Transfusion of Blood Products in Trauma – A position statement and resource document of NAEMSP.

Hemorrhagic shock remains the leading cause of potentially preventable death among injured patients with life-threatening bleeding. Prehospital resuscitation has been evolving with increasing use of blood product resuscitation. The impact of blood administration on patient outcomes remains poorly defined with significant heterogeneity in the quality of literature supporting prehospital blood product resuscitation after trauma. We completed a structured search of the literature using a rapid review framework based on three distinct PICO questions to develop systematic and consensus recommendations. The National Association of Emergency Medical Services Physicians (NAEMSP) recommends, in EMS agencies/systems that can support a high-quality prehospital blood transfusion program:Use of blood components over crystalloids for the first-line treatment of patients with traumatic life-threatening bleeding in the prehospital phase of resuscitationUse of low titer group O whole blood (LTOWB) as the first-choice blood product for treatment of patients with traumatic life-threatening bleeding in the prehospital phase of resuscitationUse of a combination or composite of prehospital transfusion indications, focused on physiologic abnormalities and/or injury patterns with obvious significant blood lossUse of active monitoring for transfusion-related adverse eventsDeveloping a mechanism to recycle unused blood product units nearing their expiration date to a high-use hospital facility to minimize wastageEngaging in a comprehensive longitudinal active collaboration between EMS agencies, trauma centers, and blood suppliers to ensure the success of a prehospital transfusion program Use of blood components over crystalloids for the first-line treatment of patients with traumatic life-threatening bleeding in the prehospital phase of resuscitation Use of low titer group O whole blood (LTOWB) as the first-choice blood product for treatment of patients with traumatic life-threatening bleeding in the prehospital phase of resuscitation Use of a combination or composite of prehospital transfusion indications, focused on physiologic abnormalities and/or injury patterns with obvious significant blood loss Use of active monitoring for transfusion-related adverse events Developing a mechanism to recycle unused blood product units nearing their expiration date to a high-use hospital facility to minimize wastage Engaging in a comprehensive longitudinal active collaboration between EMS agencies, trauma centers, and blood suppliers to ensure the success of a prehospital transfusion program