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Giving packed red blood cells in the prehospital phase of care... a good idea?

Stephen Richey stephen.richey at gmail.com
Fri Apr 6 20:25:44 BST 2012


For the most part, I would say no at least here in the US since the average
level of education for a paramedic leaves much to be desired (speaking as a
former EMS educator myself).  The issues with quality control, supply
maintenance, the need to determine clinical need (EMS providers tend to
massive over-estimate the severity of patients' conditions because most of
them are taught "cookbook" defensive medicine) and cost.  I am not sure how
the blood banking situation is in other countries but here there are often
region-wide shortages of blood products so the sequestration of a
significant amount in the hands of EMS providers would probably only
exacerbate the situation.

Also, the problem is worsened by the fact that the patients who would
probably benefit most from field transfusions are the ones in the areas
least suited to its use because of administration, training and supply
issues.  Rural EMS tends to be almost all volunteer and many of these folks
never even meet their medical director let along receive any meaningful
QA/QI feedback.  The idea of giving the blood to the local HEMS operators
and using them to deliver a higher level of care isn't going to work
because you're going to delay the arrival of the patient in the OR in all
but the most remote of areas.

In urban settings, you're not going to have that much need for transfusion
because of the proximity to trauma centers.  Here for example, it's
abnormal for EMS providers (such as my fiancee) to take longer than 20
minutes from call to arrival at the hospital.

On Fri, Apr 6, 2012 at 3:12 PM, Karim Brohi <karim at trauma.org> wrote:

> So our trauma helicopter emergency medical service recently started
> carrying packed cells:
> http://www.bbc.co.uk/news/health-17232529
>
> We'll obviously be auditing its use closely, but I'm interested in
> garnering the lists opinions on this:
> Who should get PRBCs?
> Should anyone get PRBCs?
> Why aren't we carrying plasma as well?
>
> There are a couple of prehospital services in the US carrying blood
> and plasma to my knowledge, and it is used by MERT teams in combat
> zones.
>
> So??
>
> Karim
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-- 
Stephen Richey
Founder and Chief Researcher/Designer
Kolibri Aviation Safety Research
5174-B Winterberry Circle
Indianapolis, IN 46254
317-985-4740

 "I think the best thing, and the only thing in our infinite inadequacy in
making up for the loss of life, is to say something we have been able to
say in a lot of other accidents to grieving families.  That is 'Those
deaths will not be in vain. We will not let them be in vain. Every one of
those lives will be made to count in terms of making sure that three, four,
five or ten other people do not die."- John J. Nance


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