Frequently Asked Questions

Pre-Hospital Whole Blood really is the latest and greatest treatment to come to EMS. Hemorrhage is the #1 cause of preventable death in trauma. Studies have shown that patients who meet pre-hospital blood transfusion criteria have as high as a 70% mortality rate if the blood they need is not transfused before arriving at the hospital. With pre-hospital blood transfusions, we have seen that mortality rate reduced to 20% or less!

A unit of Low Titer O+ Whole Blood (LTO+WB) contains only two things: approximately 500 ml of blood that is drawn from one donor, plus 70 ml of a preservative called Citrate Phosphate Dextrose Adenine (CPDA). The preservative is neutralized by administering calcium.

Protocols vary from agency to agency, but most generally include some of the following criteria:

Systolic BP < 90

Heart rate > 120

Shock Index > 1 (HR > SBP)

Pulse Pressure <45

ETCO2 < 25

Actually, it's not much more complicated than administering IV fluids; the blood just needs to be warmed during the infusion. The logistics of obtaining and storing the blood can be the complicated part.

Component therapy is typically more complicated to store and administer, and more expensive than whole blood.

Normal Saline and Lactated Ringers do nothing more than simple fluid replacement, often resulting in only a transient improvement in blood pressure. Meanwhile, they are actually causing the patient harm because they are acidotic, cold, do not carry oxygen, and do not clot.

Studies have shown that delaying a needed blood transfusion can lead to: a drastic increase in mortality (as high as 11% every minute that blood is delayed), an increase in the need for patients to be intubated, and an increase in total units of blood needed to treat a patient over their course of care.

Low Titer O+ Whole Blood (LTO+WB) is the most commonly transfused blood type in the pre-hospital setting because it is more readily available than O- (the universal donor, but also the rarest blood type), and it is approved by the Association for the Advancement of Blood & Biotherapies (AABB) for emergency use in patients with unknown blood typing.

There are multiple studies that suggest that if pre-hospital whole blood was available to everyone in the US who needed it, then potentially 54,000 to 900,000 lives could be saved every year!

Pre-Hospital Whole Blood Transfusions started in 2017. 

According to the Prehospital Blood Transfusion Initiative Coalition, as of June 2024 there are at least 158 EMS agencies in the US that carry blood, and thankfully this number is constantly growing.

Isoimmunization can occur when a woman of childbearing age with an Rh- blood type receives Rh+ blood and her body subsequently creates antibodies toward Rh+ blood. She would then have to become pregnant from an Rh+ male and if the fetus becomes Rh+, her body's antibodies would then attack it. This is extremely rare (0.8% according a study by Yazer, et al.) and easily treated with standard pre-natal care and a medication called RhoGAM. Because isoimmunization is extremely rare and easily treated, Low Titer O+ Whole Blood (LTO+WB) is recommended by the Association for the Advancement of Blood & Biotherapies (AABB) for emergency transfusions to recipients of unknown blood type.

Allergic reactions are rare thanks to LTOWB's low titer profile (Anti-A and Anti-B IgM are <1:250), and are easily treated by paramedics just like any other allergic reaction.

There are a few options for storage and transfusion equipment that run around $5,000 per unit as start-up cost. We can help recommend equipment to suit your agency's needs.

Costs vary depending on the blood bank and program, but the national average is between $500-750 per transfusion. We can help identify ways to minimize these costs.

The commonly accepted shelf life of a unit of Whole Blood is 35 days if stored properly at 0-7 degrees Celsius.

Is it possible to start a whole blood program for your EMS agency on your own? Sure. However, we're here to take our years of expertise, knowledge, and lessons learned, and make implementing a whole blood program at your agency easier--saving you time, headaches, and money. Our focus is to identify and meet your agency's needs, provide superior education and customer service, make your agency comfortable transfusing blood, and ultimately save lives.