Prehospital Trauma Compendium: Transfusion of Blood Products in Trauma - A Position Statement and Resource Document of NAEMSP.
Prehospital Emergency Care · 2025-03-25 · Guideline / consensus
Abstract
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 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.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Blood products · Fluids & blood · Implementation
Related articles
- Best practices on blood and blood products for a prehospital hemorrhage protocol: consensus from the 2025 Canadian prehospital transfusion summit. (Scand J Trauma Resusc Emerg Med, 2026)
- Prehospital Blood Transfusion Coalition: framework for EMS Blood Program Coordinator responsibilities. (Trauma Surg Acute Care Open, 2026)
- How we implement a prehospital transfusion program. (Transfusion, 2025)
- Prehospital low-titer group O whole blood in a multi-agency civilian emergency medical system: Operational timelines, physiologic response, and stewardship across trauma and medical hemorrhage. (Transfusion, 2026)
- Expanding access to prehospital blood products: a narrative review of clinical evidence, systems barriers, and statewide strategies. (Trauma Surg Acute Care Open, 2026)
- How do we implement a prehospital whole blood administration program for shock trauma patients on a statewide basis? (Transfusion, 2025)