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Oral Abstract

Transfusion Service - Trauma and Massive Transfusion Practices

Oral Abstract Session - Insight into Whole Blood and Hemorrhage Management

#OA3-AM25-SN-31 - Characterizing 2024 Pre-Hospital Blood Product Administrations in the U.S. using the National EMS Information System

Sunday, October 26, 2025
8:15 AM - 9:15 AM  PT
Room: SDCC 30AB
Oral Abstracts

    Presenting Author(s)

  • JK

    Jeremiah Kinsman, n/a

    National Highway Traffic Safety Administration

    Disclosure information not submitted.

Background/Case Studies: Blood product administration has traditionally been used by air medical and advanced interfacility EMS but is a relatively new intervention for ground-based emergency response agencies. Existing literature demonstrates that out-of-hospital blood transfusion is a safe and effective strategy for reducing morbidity and mortality. This study characterizes out-of-hospital blood transfusion practices for air, interfacility, and ground-based EMS agencies.   

Study

Design/Methods: We conducted a retrospective analysis of blood product administrations in 2024 using NEMSIS data. EMS activations were included if EMS clinicians administered one of the following types of blood products in the out-of-hospital setting: transfusion of platelets, whole blood, albumin, fresh frozen plasma, cryoprecipitate, packed red blood cells, or administration of an unspecified blood product. Frequency distributions were calculated to characterize patient demographics, cause of injury, clinical impressions and symptoms, and attributes of the EMS agencies. We analyzed measures of central tendency for vital signs recorded before and after transfusion, quantifying the magnitude and direction of change, and assessed transfusion-related complications

Results/Findings: 60,525,710 records, submitted by 14,640 EMS agencies from 50 States, DC, and 3 U.S. Territories were included in the analysis. Out-of-hospital blood transfusions were documented in 21,160 records (.03%). Of these, 84% (n=17,710) were administered during interfacility transfers, and 48% (n=10,064) were provided by ground-based EMS clinicians. Patient demographics show that 6% (1,202) of blood transfusions were administered to pediatric patients (<18 years old). EMS clinicians documented injuries in 16% (n=3,396) of transfused patients. The primary causes of injury were motor vehicle crashes (11% [2,320]) and inter-personal violence (8% [1,674]). For medical patients, the most frequent clinical impressions were gastrointestinal bleeding (22%, [4,824]), obstetrical emergencies (2.9% [605]), altered mental status (1.8% [384]), and sepsis (1.4% [291]). For ground-based emergency responses administering blood, the initial recorded vital signs showed a mean systolic blood pressure of 74 mmHg, a mean heart rate of 68 beats per minute, and a mean shock index of 0.91. End-tidal carbon dioxide was documented in 52% (n=10955)  of these cases, with a mean value of 28 mmHg. 

Conclusions: These findings underscore the critical role and increasing utilization of out-of-hospital blood transfusion, as well as the utility of a large and comprehensive national EMS database in monitoring these interventions across the United States. Continued collection and analysis of EMS data related to blood transfusions will provide essential insights for optimizing clinical practice, enhancing EMS and blood supplier operations, and advancing our understanding of how these interventions impact outcomes.