Deployment of Low-Titer O-Positive Whole Blood in the Prehospital Environment

Introduction—Trauma patients bleed whole blood. Over the last three decades trauma patients requiring resuscitation have typically received blood component therapy: red blood cells, primarily, although recently plasma and platelets have been added in a 1:1:1 ratio. Blood-based resuscitation is within the scope of very few prehospital providers. Providing transfusion at the point of injury has resulted in improved clinical outcomes.

Objective—To examine the deployment of low-titer O-positive whole blood (LTOWB) to the prehospital environment.

Methods—The Southwest Texas Regional Advisory Council for Trauma led a multidisciplinary, multi-institutional regional prehospital LTOWB program in Southwest Texas. The program capitalized on existing rural air-medical capabilities and two adult Level I trauma centers (one county-based and one military). Protocols developed by the Army Blood Program for LTOWB were adopted by the South Texas Blood and Tissue Center, which in turn established a donor recruitment program (Brothers in Arms) to meet the needs for sustainability of a large regional LTOWB program. Healthcare providers were trained on administration of LTOWB. In an effort to minimize wastage and maximize use, a system for cycling product to the county-based Level I trauma center was established.

Results—The LTOWB rollout to 14 rural and urban air-medical bases began in January 2018. There have been several documented uses of LTOWB under this program; outcomes appear favorable initially. To date no complications have occurred, and zero LTOWB has been wasted due to cycling prehospital units into the Level I trauma center three weeks before expiration. Five additional air-medical bases outside of the original program participants have begun carrying LTOWB. A large urban ground EMS agency in the region anticipates deployment of LTOWB by special operations and supervisor vehicles as part of systemwide program expansion.

Conclusion—A robust whole blood program required the integration and collaboration of an interdisciplinary stakeholder team to provide clinical and administrative education, cold chain management, and donor sustainability; and ensure product accessibility and prudent utilization. The LTOWB program identified necessary infrastructure to scale to additional prehospital platforms and other trauma systems in order to improve clinical outcomes for trauma.