Whole Blood Transfusion: The Next Frontier for EMS

Every second counts in trauma care. When a patient experiences life-threatening blood loss, the first hour—often called the golden hour—can determine survival. Hemorrhagic shock accounts for 30-40% of trauma-related deaths, making rapid intervention critical.

For decades, EMS has relied on blood component therapy, which was favored for its longer shelf life, efficiency, and lower risk of transfusion reactions. However, in cases of severe hemorrhage, administering whole blood early can prevent further deterioration—especially in rural and remote areas, where transport times are longer and the risk to patients is higher.

The Impact of Whole Blood in EMS

As more agencies revisit whole blood transfusion, data shows why this shift is happening:

• Patients with penetrating trauma and low blood pressure who received prehospital whole blood had a 7% in-hospital mortality rate, significantly lower than those who received blood after hospital arrival.
• Washington, D.C. fire and EMS paramedics saw a 92% survival rate for patients not in cardiac arrest and a 77.2% for those in cardiac arrest after launching a whole blood program.
• A study of nearly 1,400 trauma patients showed a 60% improvement in 30-day survival rates with whole blood compared to component therapy.
• A South Texas program saw trauma-related deaths drop nearly 50%.

More EMS agencies are adopting whole blood transfusion—from just seven in 2018 to 156 as of June 2024. But that still accounts for only 1% of EMS agencies nationwide. If whole blood is proving so effective, why aren’t more EMS agencies using it? The answer comes down to logistical, regulatory, and resource challenges.

Challenges of Implementing Whole Blood in EMS

Despite its life-saving potential, whole blood transfusion faces significant adoption barriers in EMS. The biggest challenges include storage and transportation requirements, regulatory restrictions, training needs, and supply shortages.

Storage and Transportation Hurdles

Whole blood must be stored at specific temperatures and has a limited shelf life—typically 21 to 35 days. Maintaining proper storage conditions in ambulances requires specialized refrigeration and monitoring equipment, adding to operational costs.

Additionally, EMS agencies must comply with strict federal and state regulations for storing, transporting, and administering whole blood. This means agencies must establish detailed protocols and ensure EMS personnel receive proper training, which can be resource-intensive.

Limited Blood Supply

Even when EMS agencies are ready to implement whole blood programs, finding a reliable supply can be a challenge. Whole blood must be low titer, O+, a universal donor type used for emergency transfusions. However, supply shortages—exacerbated by the COVID-19 pandemic—continue to impact availability.

Hospitals and trauma centers typically take priority in blood allocation, leaving EMS agencies struggling to secure a consistent supply. Without a steady source, implementing a whole blood program becomes unsustainable.

Solutions for Overcoming These Barriers

Despite these challenges, EMS agencies can take steps to make whole blood transfusion a reality.

1. Securing Funding & Resources

Agencies can apply for grants and government funding to cover the cost of:

• Training programs for EMS personnel.
• Specialized refrigeration and monitoring systems for ambulances.
• Regulatory compliance measures to meet storage and transportation requirements.

Providing the long-term benefits of prehospital whole-blood transfusions can also help agencies secure financial support. For example, in New Orleans, a healthcare system demonstrated that providing whole blood in the field contributed to a drop in the city’s murder rate. This compelling data helped secure funding and long-term commitment to the program.

2. Expanding Blood Supply Partnerships

To secure a steady source of whole blood, EMS leaders should explore partnerships with blood banks, hospitals, and community organizations.

A successful example is the San Antonio Fire Department’s “Heroes in Arms” program. Local residents regularly donate blood exclusively for SAFD’s EMS teams, ensuring a dedicated supply for prehospital transfusions. Any unused blood is sent to a regional trauma center, maximizing its use.

EMS agencies can also work with state and local governments to raise awareness and encourage public donations specifically for emergency transfusions. By educating the public on the importance of whole blood in EMS, agencies can create a more sustainable supply chain.

Developing Documentation Protocols

Whole blood transfusions require accurate documentation and reporting, but the process doesn’t have to be complicated. With configurable Power Tools in ImageTrend Elite, EMS teams can document whole blood treatment with just one click—ensuring efficiency while keeping the focus on patient care.

As more agencies implement whole blood programs, standardized documentation practices will continue to evolve. Within Elite, Power Tools provide a way for agencies to configure workflows and streamline documentation based on their specific needs.

To further support EMS teams, ImageTrend is working on publishing a default Power Tool in the ImageTrend Library, making it even easier for agencies to adopt a standardized approach.

One of our customers, the Burnsville Fire Department in Minnesota, recently became the first in the state to carry whole blood for transfusions. As more agencies launch similar programs, having efficient, user-friendly documentation tools will be critical to ensuring smooth adoption and compliance—and Elite is designed to support this process seamlessly.

Expanding Access to Whole Blood in EMS

Whole blood transfusion is saving lives—but many EMS agencies still face barriers in developing a program and securing a consistent, reliable blood supply.

Fortunately, EMS and fire departments across the country are proving that it can be done. Agencies can learn from successful whole blood programs and replicate proven frameworks to overcome challenges. By publicizing the life-saving impact of prehospital blood transfusions, EMS leaders can strengthen their case for grants and funding—helping secure specialized storage equipment and sustainable blood supply partnerships.

As more EMS agencies implement whole blood transfusion, the impact on patients, families, and communities will continue to grow. The momentum is building—now is the time to expand access to this life-saving treatment.

Interested in streamlining whole blood documentation? Learn how ImageTrend Elite can help your agency simplify reporting and ensure compliance. Contact us today to get started.