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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- $250 for Non-NYU Learners

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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
Evaluating:
- Indications
- Protocol adherence
- Time to transfusion
- Early outcomes
Too early for outcome conclusions

California collaboration

Multiple active programs:
- Riverside (Corona Fire)
- LA County
- Ventura County
Additional programs planned:
- Sacramento
- San Bernardino
Programs meet monthly as CalDROP
Focus on shared learning and operational optimization

Barriers and concerns

Trauma surgeon concerns about blood supply
Need for system wide buy in
Community engagement
Patients who may decline transfusion
Women of childbearing age and alloimmunization risk
Risk of HDFN is extremely low
Clear communication with receiving hospitals is essential

Future direction

Rapid national expansion expected
Greatest benefit likely where transport delays exist
Prehospital Blood Transfusion Coalition active nationally
Major unresolved issue: reimbursement
Currently funded largely by fire departments
Sustainability depends on policy and payment reform

Take-Home Points

Hemorrhagic shock is best treated with blood, not crystalloid
Prehospital transfusion may benefit patients with prolonged transport times
Implementation requires strong partnerships with blood banks and trauma centers
Early data are promising, but patient selection remains critical
National collaboration is key to sustainability and future growth

Episode 217: Prehospital Blood Transfusion

Core EM - Emergency Medicine Podcast