Blood Administration in Haemorrhagic shock within EMS systems

Pre-Hospital Care Podcast

This episode continues our series on traumatic bleeding, focusing on the use of blood transfusions in prehospital settings. While blood transfusions are life-saving for haemorrhagic shock, evidence on prehospital blood use is mixed. Civilian and military studies show improved outcomes with prehospital blood, but the 2022 RePHILL trial found no superiority over sodium chloride for trauma-related hemorrhagic shock - https://www.thebottomline.org.uk/summaries/icm/rephill/. Despite this, haemostatic resuscitation has evolved to be the standard care for bleeding-induced shock in the UK. Currently, only physicians in HEMS systems can administer prehospital blood under UK paramedic guidelines, with paramedics limited to using sodium chloride.

The 2007 Manchester Arena bombing inquiry considered frontline ambulances carrying blood products but deemed it infeasible for clinical and logistical reasons. It recommended that specialist teams, such as the Hazardous Area Response Team (HART), carry freeze-dried plasma. Southwestern Ambulance Service HART has since trialed Lyoplas.

This episode discusses paramedic-administered blood products outside of HEMS systems, featuring Dr. Peter Chesney, Lt. Col. (retired) Randy Shaffer, and Dr. Chesney, a pediatric emergency physician and medical director in South Florida. Lt. Col. Shaffer, a former Emergency and Trauma nurse in the U.S. Army, established prehospital programs and walking blood banks during her deployments and has since worked on regional blood coalition initiatives. Dr. Chesney, a seasoned trauma surgeon, has received numerous accolades, including the Outstanding Clinical Research Achievement Award, and co-founded the international damage control resuscitation educational program.

This episode is sponsored by the International Critical Care Paramedic Group (ICCPG):

The ICCPG are dedicated to advancing global Paramedicine through knowledge sharing and improved communication. Join their second conference on January 30, 2025, following the success of their 2022 event, which united over 600 paramedics worldwide. This virtual event will feature detailed case studies and in-depth clinical, training, leadership, and research discussions. Don't miss this opportunity to connect with peers and learn from international experts. For more details, contact Christian Wiggin at [e-mail]

This podcast is sponsored by the University of Hertfordshire.

The University of Hertfordshire’s MSc Advanced Paramedic Practice offers flexible, part-time study with some online options. Students can choose between two pathways: Primary and Urgent Care or Emergency and Critical Care. The program includes modules in leadership, coaching, and independent prescribing. Expert, research-active staff with national and international profiles deliver innovative teaching using online, VR, and simulation technology. With over 25 years of heritage, the program promises excellent career prospects and opportunities for further research through Masters by research and PhDs. Please see here for further details:

https://www.herts.ac.uk/courses/postgraduate-masters/msc-advanced-paramedic-practice2?utm_campaign=pg_maincycle24&utm_medium=pre_hosp_care_podcast&utm_source=podcast&utm_id=paramedic