ACS: EMS Whole Blood Transfusions Could Save 10,000 Lives Annually

If every ambulance in the United States carried whole blood for in-the-field transfusions, “probably 10,000 lives a year could be saved,” stated John B. Holcomb, MD, a professor in the UAB Heersink School of Medicine’s Division of Trauma & Acute Care Surgery. Holcomb was one of four panelists calling for this to happen during an American College of Surgeons (ACS) news conference in San Francisco. The ACS held their Clinical Congress 2024 in the city October 19–21, 2024.

The point of the ACS news conference, which was held in person and live online October 21, was to promote the use of prehospital whole blood transfusions by EMS agencies nationwide. There are two reasons why having EMS administer whole blood transfusions could save up to 10,000 U.S. lives annually. First, “trauma is the leading cause of death in the United States,” said Holcomb. Second, “hemorrhage is the leading cause of potentially preventable death.”

Unfortunately, only about 1–2% of EMS air and ground ambulances carry whole blood, Holcomb said, and “only about 1% of patients who could receive blood receive blood every day in the United States.” As for the bags of clear saline that most ambulances do carry? “If you're bleeding, [it] increases your [chances of] death,” he noted.

Holcomb’s assessment of how many U.S. ambulances carry whole blood is an average across rural and urban areas. In rural areas exclusively, “we're down to almost zero [percent],” said panelist Michael Person, MD, associate professor of surgery at the University of South Dakota Sanford School of Medicine. “The only way you're going to get prehospital blood is probably by air flight, which is challenging if you live in a rural community.”

One exception to this absence of prehospital blood can be found in the U.S. military. “We started fielding prehospital blood in 2012,” said Col. Jennifer Gurney, chief of the Department of Defense’s Joint Trauma System. “The initial study that came out in 2017 demonstrated a fourfold increase in survival in the first 24 hours. So [a] fourfold increase in survival and that survival was also for 30 days, [with] decreased 30 day mortality by threefold. So a huge lifesaving capability.”

Clearly, “we really need to take down some of the barriers that some of our EMS agencies are facing to get this lifesaving intervention into the field,” said panelist Peter E. Fischer, MD, MS, NRP, associate professor of surgery at the University of Tennessee Health Science Center in Memphis.

Chief among these barriers is money backed by political will: “Congress needs to add money to CMS’ budget so that they can pay reimbursements,” Holcomb said. “That's just the way health care works in the United States. And then happens, then private insurance will follow; again, [that’s] healthcare economics in the United States. That's the way it works. And it starts with this kind of effort that the college has helped lead.”

Some U.S. EMS agencies have already implemented prehospital whole blood administration, such as DC Fire and EMS in Washington, DC. “There are some EMS agencies out there that are doing an amazing job with this, and the best part is that none of them want this to be proprietary,” Fischer said. “They're willing to share their information and get this out, which shows just how important it is to everyone.”

Still, many obstacles have to be cleared before all U.S. ambulances can carry whole blood as standard procedure. Again, money is the big one, and it has to come from somewhere: “We've got to find a way to make it cost neutral so that the EMS agencies don't have to take a hit when they give this lifesaving treatment,” said Fischer. “As Dr. Holcomb said, it's only 1–2% right now [doing pre-hospital whole blood transfusions]—that's about 175 ground crews over the United States. A lot of them are doing that at their own cost, which is fantastic for them. But in the rural communities, 50 percent of these EMS agencies are volunteer-run, and the volunteer agencies do not have the resources to be able to flip the bill on their own.”