
Early access to blood after trauma is critical to patient survival.
One study found up to 5% increased odds of mortality for every minute of delay in access to blood. Community blood centers are at the forefront of efforts to provide blood and blood products for use in the prehospital setting. In 2023, ABC members supplied over 32,000 blood and blood products to an emergency management system in support of their prehospital transfusion program.
The Problem
More and more EMS agencies have recognized this need and begun carrying blood on ground and air ambulances, with the Centers for Medicare and Medicaid Services (CMS) estimating that the demand for pre-hospital transfusion programs will double in the next year. As demand grows, significant barriers impede the expansion of access to pre-hospital blood transfusions:Â
- The majority of health care payers, including Medicare, Medicaid, TRICARE, and many private insurers, provide insufficient payments to support the use of blood by Emergency Medical Services (EMS) providers, with a single unit costing more than half of the Medicare reimbursement for the highest level of EMS care. Currently EMS agencies that provide pre-hospital blood rely heavily on grant funding or the ability to absorb the cost of storing and transfusing blood.
- State and local licensure requirements can vary regarding the type of care a paramedic is allowed to provide, including the ability to start a blood transfusion.
- Pre-hospital transfusions often rely on universal blood types, placing increased strain on a scare resource and requiring increased donor recruitment efforts. In fact, one study found that a lower bound of 54,160 additional whole blood units annually would be required to meet the needs for the pre-hospital setting.

Take Action
CMS, Congress, and federal and state agencies must take action to create and fund a comprehensive effort to assign specific reimbursement for blood transfusions administered in the pre-hospital space and establish programs to increase the number of blood donors required for this new aspect of care.
Add your voice to these efforts by sending customizable, prewritten messages to your Members of Congress - it takes only minutes but could have a lasting impact.
Latest Developments
Resources
A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.
The National Academies of Sciences, Engineering, and Medicine (NASEM) has called for "Zero Preventable Deaths After Injury" in this landmark report.
NBC Nightly News Special Investigation
Watch this special investigation on the importance of pre-hospital blood transfusions and see why these programs have been endorsed by a variety of national trauma and first responder organizations, including the American College of Surgeons, American College of Emergency Physicians, International Association of EMS Chiefs, and National Association of EMS Physicians.
Prehospital Blood Transfusion Initiative Coalition
As a member of the Prehospital Blood Transfusion Initiative Coalition steering committee, ABC and our members have played an active role in shaping reforms to these policies.
U.S. Prehospital Blood Program Interactive Map
In cooperation and with support from the Blood Centers of America, the Prehospital Blood Transfusion Initiative Coalition has developed an interactive map showing ground EMS agencies which are conducting blood transfusion programs.
Bleeding to Death in a Big City: An Analysis of all Trauma Deaths from Hemorrhage in a Metropolitan Area During 1 Year
This study conducted by Kyle J Kalkwarf and colleagues analyzes trauma-related deaths from hemorrhage in Harris County, Texas, to identify opportunities for preventing preventable hemorrhagic deaths.
Access to Immediately Available Balanced Blood Products in a Rural State's Trauma System
This study conducted by W. Andrew Smedley et al. analyzes access to balanced blood products in trauma centers within the Arkansas Trauma System.
Preferential Whole Blood Transfusion During the Early Resuscitation Period is Associated with Decreased Mortality and Transfusion Requirements in Traumatically Injured Patients
Researchers from multiple institutions conducted a study demonstrating that preferential whole blood transfusion in trauma patients was associated with reduced mortality and transfusion requirements, urging further research on optimal whole blood use.
Removing the Barriers to Prehospital Blood: A Roadmap to Success
A review on prehospital blood programs in the United States, detailing the barriers and proposed strategies for successful implementation, conducted by Randall M. Schaefer et al.
Making Blood Immediately Available in Emergencies
A study conducted by John B. Holcomb and colleagues regarding the immediate availability of blood in emergencies.
Pre-Hospital Transfusion of Red Blood Cells. Part 1: A Scoping Review of Current Practice and Transfusion Triggers
A scoping review on pre-hospital transfusion of red blood cells conducted by Elisabeth C. van Turenhout, Sebastiaan M. Bossers, Stephan A. Loer, Georgios F. Giannakopoulos, Lothar A. Schwarte, and Patrick Schober from various departments in Amsterdam UMC and Vrije Universiteit Amsterdam, The Netherlands.
Realignment of EMS Reimbursement Policy: New Hope for Patient-Centered Out-of-Hospital Care
A viewpoint article conducted by Kevin G. Munjal, Gregg S. Margolis, and Arthur L. Kellermann, published in JAMA in 2019
Every Minute Counts
This study conducted by a team of researchers investigated the impact of delays in the delivery of initial massive transfusion cooler on patient outcomes, highlighting the importance of timely activation and delivery in trauma care.
Nationwide Estimates of the Need for Prehospital Blood Products After Injury
This study estimates the need for prehospital blood products after injury in the United States and was conducted by Zain G. Hashmi, Jan O. Jansen, and others from the University of Alabama at Birmingham.
An Analysis of Prehospital Deaths: Who Can We Save?
This study conducted by the Journal of Trauma and Acute Care Surgery in August 2014 analyzed prehospital deaths to identify patterns of injury and potential areas for intervention.
Blood Community Hospice Rule and RFI Comments to CMS
The national blood community hospice rule comments are available in response to the proposed hospice rule and request for information (RFI) from the Centers for…