Every second counts in trauma care. When a patient experiences life-threatening blood loss, the first hour, often called the golden hour, can determine survival. Hemorrhagic shock accounts for 30-40% of trauma-related deaths, making rapid intervention critical.
For decades, EMS has relied on blood component therapy, which was favored for its longer shelf life, efficiency, and lower risk of transfusion reactions. However, emerging data suggests that whole blood transfusion in the field could significantly improve survival rates, particularly in rural and remote areas where longer transport times pose additional risks.
The impact of whole blood in EMS
The Funding Model for Cancer Innovation is Broken — We Can Fix It
Closing cancer health equity gaps require medical breakthroughs made possible by new funding approaches.
As more agencies revisit whole blood transfusion, recent studies highlight why this shift is gaining traction:
- Early whole blood administration improves outcomes. Patients with penetrating trauma and low blood pressure who received prehospital whole blood had a 7% in-hospital mortality rate, significantly lower than those who received blood after hospital arrival.
- Washington, D.C. fire and EMS paramedics saw a 92% survival rate for patients not in cardiac arrest and 77.2% for those in cardiac arrest after launching a whole blood program.
- A large-scale study of nearly 1,400 trauma patients found a 60% improvement in 30-day survival rates with whole blood compared to component therapy.
- A South Texas initiative saw trauma-related deaths drop nearly 50% following the introduction of prehospital whole blood transfusions.
Despite these promising results, adoption remains limited. In 2018, only seven EMS agencies in the U.S. carried whole blood. By mid-2024, that number had grown to 156, but this still represents just 1% of EMS agencies nationwide. If whole blood is proving so effective, why isn’t its use more widespread? The answer lies in logistical, regulatory, and resource-related challenges.
Challenges of implementing whole blood in EMS
Using Data to Help Healthcare Practices Succeed
A new report from Relatient, A Data-Driven Guide to Patient Access Succes, highlights how focusing on data accuracy and relevance can enhance the performance of healthcare practices.
Whole blood transfusion presents several hurdles for EMS agencies, particularly regarding storage, transportation, regulatory constraints, and supply shortages.
- Storage and transportation hurdles : Whole blood must be stored at specific temperatures and has a limited shelf life, typically 21 to 35 days. Maintaining proper storage conditions in ambulances requires specialized refrigeration and monitoring equipment, adding to operational costs. Additionally, EMS agencies must comply with strict federal and state regulations for storing, transporting, and administering whole blood. This means agencies must establish detailed protocols and ensure EMS personnel receive appropriate training, which can be resource-intensive.
- Limited blood supply: Whole blood used in emergency settings must be low-titer O+, a universal donor type for rapid transfusions. However, ongoing shortages — exacerbated by the Covid-19 pandemic — have made it difficult to secure a steady supply. Hospitals and trauma centers often receive priority in blood allocation, leaving EMS agencies struggling to maintain inventory.
Solutions for overcoming these barriers
1. Securing funding & resources – Grant programs and government funding can help cover the cost of:
- Training programs for EMS personnel
- Specialized refrigeration and monitoring systems
- Compliance measures for storage and transportation regulations
Demonstrating the long-term benefits of pre-hospital whole-blood transfusions can also help agencies secure financial support. In New Orleans, for example, a healthcare system reported that access to whole blood in the field correlated with a reduction in the city’s violent crime fatality rate. Such compelling data can strengthen the case for funding and long-term program sustainability.
2. Expanding blood supply partnerships – To ensure a steady supply of whole blood, EMS leaders might consider partnerships with regional blood banks, hospitals, and community organizations. One successful example is the San Antonio Fire Department’s Heroes in Arms program, where local residents donate blood exclusively for SAFD’s EMS teams. This ensures a dedicated supply for prehospital transfusions while also allowing unused units to be redirected to trauma centers, reducing waste.
Developing standardized documentation protocols
Accurate documentation is critical in whole blood transfusion, both for patient safety and compliance with regulatory requirements. As more EMS agencies integrate whole blood programs, establishing clear, standardized protocols will be essential.
Several EMS regions are working to simplify the process by implementing streamlined electronic documentation tools, reducing administrative burdens on providers. Ensuring efficiency in reporting allows EMS personnel to focus on patient care while maintaining compliance.
Whole blood transfusion is saving lives — but barriers to adoption remain. By leveraging lessons from successful programs and advocating for funding, EMS leaders can build the necessary infrastructure to support prehospital transfusions.
As more agencies implement whole blood initiatives, the impact on trauma survival rates will continue to grow. The momentum is building — now is the time to expand access to this life-saving treatment.
Picture: manopjk, Getty Images
Joe Grawis the Chief Growth Officer at ImageTrend. Joe’s passion to learn and explore new ideas in the industry is about more than managing the growth of ImageTrend - it’s forward thinking. Engaging in many facets of ImageTrend is part of what drives Joe. He is dedicated to our community, clients, and their use of data to drive results, implement change, and drive improvement in their industries.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.