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Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study

Published online by Cambridge University Press:  19 April 2018

Felicia M. Mix ,
Martin D. Zielinski ,
Lucas A. Myers ,
Kathy S. Berns ,
Anurahda Luke ,
James R. Stubbs ,
Scott P. Zietlow ,
Donald H. Jenkins  and
Matthew D. Sztajnkrycer
Felicia M. Mix
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
Martin D. Zielinski
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, MinnesotaUSA
Lucas A. Myers
Affiliation:
Mayo Clinic Medical Transport, Mayo Clinic, Rochester, MinnesotaUSA
Kathy S. Berns
Affiliation:
Mayo Clinic Medical Transport, Mayo Clinic, Rochester, MinnesotaUSA
Anurahda Luke
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA Mayo Clinic Medical Transport, Mayo Clinic, Rochester, MinnesotaUSA
James R. Stubbs
Affiliation:
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MinnesotaUSA
Scott P. Zietlow
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, MinnesotaUSA
Donald H. Jenkins
Affiliation:
Department of Surgery, UT Health San Antonio, San Antonio, TexasUSA
Matthew D. Sztajnkrycer*
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
*
Correspondence: Matthew D. Sztajnkrycer, MD, PhD Associate Professor of Emergency Medicine Mayo Clinic GE-GR-G410 200 1st Street SW Rochester, Minnesota 55905 USA E-mail: [email protected]
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Abstract

Introduction

Hemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).

Methods

This was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).

Results

A total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.

Conclusions

In this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.

MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study. Prehosp Disaster Med. 2018;33(3):230–236.

Keywords

blood productshelicopter EMSresuscitationtransfusiontrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 3 , June 2018 , pp. 230 - 236
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: The authors report no conflict of interests. Portions of this manuscript were presented at the 20th World Association for Disaster and Emergency Medicine Congress on Disaster and Emergency Medicine; Toronto, Ontario; April 2017.

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