To expand access to blood products in emergency settings, America’s Blood Centers is asking Congress to establish a demonstration project through the Center for Medicare & Medicaid Innovation examining the use of pre-hospital blood.
Blood provided to patients as quickly as possible after trauma can save patients’ lives. Unintentional injury is the leading cause of death among individuals ages 1-44. Hemorrhage is the leading cause of preventable death following a severe injury, and sadly, up to 56% of those victims die before ever reaching the hospital. When trauma occurs, time is of the essence. The faster a patient receives the necessary care, the more likely they are to survive.
- One study found up to 5% increased odds of mortality for every minute of delay in access to blood.
- The National Academy of Sciences has recommended that achievement of zero preventable deaths after traumatic injury should be the goal of a national trauma system. The Department of Transportation prioritized improving post-crash care by including it as one of the objectives within the National Roadway Safety Strategy.
- Initiation of a blood transfusion is associated with significantly improved survival for trauma patients, especially those with prolonged transportation time.
- Reimbursement: Medicare payments are currently insufficient to support the use of blood by Emergency Medical Services (EMS) providers (with a single unit costing more than half of the reimbursement for the highest level of EMS care). Current funding relies heavily on grant funding or a hospital or EMS absorbing the cost of storing and transfusing blood.
- Scope of Practice: State and local licensure requirements can vary regarding the type of care a paramedic is allowed to provide.
- Blood Supply: Pre-hospital blood use is of non-crossmatched blood, so having access to blood that is less likely to be reactive in a variety of patients is essential. The most common blood components provided for pre-hospital use is Low Titer Type O Whole Blood, Type O Positive red blood cells, and Type A liquid plasma. Ensuring the availability of these high demand products is a continual challenge for blood centers. One study found a lower bound of 54,160 additional whole blood units would be required to meet the needs for the pre-hospital setting.
Up to 56% of hemorrhage victims die before ever reaching the hospital. Hemorrhage is the leading cause of preventable death following a severe injury.