C.R. Carico1, T. Hurson1, R. Schaefer2, E.A. Bank3, J.B. Holcomb1, Z.G. Hashmi1 1University Of Alabama at Birmingham, Division Of Trauma And Acute Care Surgery/Department Of Surgery, Birmingham, Alabama, USA 2Schaefer Consulting, LLC, NEW BRAUNFELS, TX, USA 3Harris County Emergency Services District No. 48, KATY, TX, USA
Introduction: While tremendous progress has been made through preventive public health interventions such as road safety and vehicle safety initiatives, motor vehicle crash (MVC) mortality rates have largely stagnated in the last two decades. This has brought into sharp focus the importance of implementing life-saving post-crash care interventions such as the use of prehospital blood product transfusion to reduce MVC mortality. However, the current demand and use of prehospital blood products for patients injured in MVC is unknown. Therefore, the objective of this study is to determine the trend of prehospital blood product use among patients injured in MVCs.
Methods: Patients >14 years of age injured in MVCs that were included in the National Emergency Medical Services Information System (NEMSIS) 2020-2023 were identified. Patients were classified as eligible for transfusion if their shock index, calculated by dividing the patient’s heart rate (HR) by systolic blood pressure (SBP), was ≥1. Number and percentage of patients with shock index ≥1 who received any prehospital blood product were calculated and trends over time were reported.
Results: After exclusions, 5.1 million trauma patients were included in our analysis. Of these, 294,523 patients had a shock index of ≥1 and were considered eligible for pre-hospital transfusion of blood product. However, only 0.62% of eligible trauma patients received pre-hospital blood product between 2020 and 2023. Blood transfusion peaked in 2021 with 539 (0.74%) patients receiving pre-hospital blood product, before slightly down trending and plateauing in 2022 (n=500, 0.67%) and 2023 (n=514, 0.64%), respectively (Figure).
Conclusion: Less than 1% of hemodynamically unstable trauma patients injured in MVCs received a prehospital blood transfusion during 2020-2023. These data underscore the need to evaluate and resolve barriers to wider use of prehospital blood transfusions in patients experiencing traumatic injuries from MVCs.