ABSTRACTS
A Description of Characteristics and Outcomes for Injured Patients Receiving Prehospital Whole Blood Using a Statewide Linked EMS and Trauma Registry DatasetAuthor: Antonio Fernandez PhD, NRP | Principal Research Scientist | ESO Associate Authors: Rosner, Jessica, DrPH | Banta, Daisy, MPH | Crowe, Remle, PhD, NREMT | Preusser, Edward, C, MSBA | Myers, J. Brent, MD, MPH
Introduction Prehospital blood administration has been identified as a key factor in improving survival rates among patients with trauma-induced hemorrhage. However, statewide evaluations of prehospital blood administration have not been performed. Objective Evaluate Virginia prehospital trauma patients who received whole blood by ground EMS. Methods This retrospective study evaluated all EMS incidents from 1/1/2021-12/31/2024 in the Virginia EMS Data Repository. Inclusion criteria were: 1) 9-1-1 response, 2) documentation of whole blood administration performed by an EMS clinician, 3) patient treatment and transport, and 4) EMS documentation of injury cause. Air medical responses were excluded. Patient outcome data was obtained by linking records to the Virginia Statewide Trauma Registry. Descriptive statistics were calculated. Results There were 70 patients transported by 10 ground EMS agencies included in the study. Overall, 47.1% were injured by firearm discharges and 17.1% by motor vehicle crashes. Median time from EMS arrival on-scene to blood administration was 16.1 minutes (Interquartile range [IQR]: 11.3-25.0). 94.3% were transported to trauma centers, median transport time to trauma centers was 13.0 minutes (IQR: 12.1-26.0). The most common mechanism of injury was penetrating (68.6%). CPR and tourniquet application was performed for 20.0% and 11.4%, respectively. Most (80.0%) patients also had crystalloids administered. Tranexamic acid and calcium were administered to 15.7% and 10.0%, respectively. The median systolic blood pressure (SBP) prior to blood administration was 102 mmHg (IQR:80-130), compared to 113 mmHg (IQR: 85-132) post-administration. The median heart rate prior to blood administration was 100 (IQR: 82-122), compared to 102 (IQR: 82-116) post-administration. The median injury severity score (ISS) was 17 (IQR: 5-25). Among the 68 patients with available hospital outcome data, 70.6% survived to hospital discharge. These patient’s median ISS of 16.5 (IQR: 5-26) compared to 19 (IQR: 4-25) among those who died. Discharge location information was available for 44 surviving patients, most were discharged home (72.7%). Conclusion In Virginia, patient receipt of blood was associated with improved SBP during EMS transport. One in four patients administered whole blood had an EMS transport time of at least 26 minutes. Injured patients who received prehospital blood administration had a 71% survival rate.
|
