Blood Concept
Over 500 EMS services in the United States are now administering blood products
False
Currently just over 280 are administering blood products in the United States
Systolic Blood Pressure less than a 100 mmHg is a criterion for blood administration
False
A SBP of 90 is required in the inclusion criteria
Religious denials are not a reason to not administer blood
False
Some religions strictly prohibit the administration of blood (or its products) and In Georgia the patient has the right to refuse any treatment they do not want
CCFES protocol directs us to give TXA at 1 Gm over 1 minute
False
The new June 2025 dose is two Gms of TXA over 1 minute
In a 4-year period (2018 to 2022) Cherokee County had 27 fatal roadway fatalities
False
In that time period, this county had 87 fatal accidents, with an additional 436 serious injuries reported.
A review of calls where blood is given, or wanted to be given, will be reviewed
We will QI all calls for data pulls to ensure we are properly engaged with the pilot program. We want to also capture calls where blood was hoping to be delivered but logistically could not arrange
Any licensed Georgia Paramedic can administer blood products
False
Only those that work for EMS services that the department has been approved for post license skills and have met the training requirements.
False
The S.I. in a patient is determined by dividing the heart rate by the systolic blood pressure.
EX: HR = 118 SBP = 74 / 48
Shock Index is 1.5 which is a poor number
Children can be given blood or blood products in Georgia even if against the wishes of the family
False
The OCGA 31-9-1 allows for parents (or their designee) to approve consent or deny any treatment
We should administer blood products before we stop the patient from bleeding
False
Bleeding control of external means is always first so the patient can keep their own blood
Blood administration reaction is normal and require no additional treatment considerations
False
Signs and symptoms could be severe, so refer to the allergic reaction / anaphylaxis protocol for treatment plans
Blood is stored at 1 - 6 degrees Celsius
True
The Delta APRU cooler keeps it at a range of 1 - 6 Celsius until used
Blood can only be administered in the hospitals for surgery, in trauma center or in the battlefield by military paramedics
False
Although the military has paved the proving grounds, hundreds of EMS services around the world are now administering blood products in the prehospital setting.
Altered mental status due to a head injury means the patient is eligible for blood administration
False
The blood protocol states AMS related to possible head injury or drugs is not a criterion for administration. AMS related to tachycardia and hypotension secondary to injury or illness is within the criteria
Just because you had a previous blood administration does not mean you will react poorly to a new unit of blood
False
The risk potential for a blood reaction a second time is potentially high, so it is listed as an exclusion to getting a unit of blood
TXA for pediatric patients is only done after online medical control approves it
True
The pediatric portion of the protocol is in red, with 15 mg / kg dose IV - IO
Blood administration requires both paramedics on the call to verify the blood is in date and no apparent abnormalities with the product
True
While it may be hard to see particles in the bag, the date must be verified by two paramedics on the call
Blood is warmed to 98.6 F
False
The QinFlow Warrior warmer heats up the blood to 38 degrees C before administration, which is 100.4 F
Colloids and Crystalloids serve the same function as blood products in the prehospital setting
False
IV fluids of any kind do not stimulate blood clotting, nor do they carry oxygen to the cells
Cool - mottled skin - cyanotic - lack of peripheral pulses is a sign / symptom of poor perfusion.
Yes
These are signs / symptoms of overall shunting and poor perfusion, leading up to a better picture of circulatory collapse
We can administer blood products if we think you will be getting sicker prior to our arrival to the hospital.
False
We administer blood products based on patients that are unstable at the time and meet the criteria, not what may happen. Your anticipation of falling vital signs should however trigger you to be prepared
Blood cannot be administered through an IO access port
False
IO has been proven safe to administer blood through
If a blood reaction is noted, stop the administration of it (or liquid plasma) and remove the tubing. Replace with another IV line of normal saline
True
Any reaction requires us to stop the infusion, do not flush the line, and replace with KVO or additional saline if needed. The entire blood supplies goes to the ED, call them early as well.
Less IV fluids may not be necessary once blood products are being administered.
True
Blood products in and of themselves are roughly 500 ml of volume liquid, as well as assist with oxygen debt and clotting formation capabilities
Patients that are severely injured or ill who arrive at the trauma center with EMS prehospital blood administration (alive) will have only a 5% mortality rate over the next 24 hours
False
The first 24 hours is crucial even with EMS prehospital blood, but their mortality rate drops by 60% if they receive blood prior to arrival
High risk for critical injuries could be penetrating injury to the torso or a possible pelvic fracture. This could lead to the need for blood administration
True
Both modalities are difficult to determine actual blood loss but vital signs and perfusion models could assist in determining the need for blood administration
Spinal cord injuries can be a criteria to administer blood products
False
Spinal Injuries are not currently included in the blood administration project.
Calcium Chloride is given after blood is pushed, at 2 Gms IV - IO for adults
False
We are using Calcium Gluconate at this time.
Once the blood and plasma has been administered, we no longer need the blood bags or the tubing.
False
All components of the process are kept. The blood bags and any tubing not still connected to the patient go in the LifeFlow plastic bag and are left at the hospital after you capture the ISBT numbers off the bags.
Blood Intercepts (MedCons) may result in a few minutes delay but the value of adding blood for resuscitation to the patient is crucial
Yes
This discussion is important between the crew and MedCons to calculate the ability to intercept with blood. Quicker blood administration has significant benefit for the patient