Policy:

 

• Blood products can be requested whenever patient care can be improved by decreasing time to treatment.

 

Purpose:

 

• Improve patient care in pre-hospital setting
• Provide timely access to life-saving treatment of blood products.

 

Criteria for request of Blood Products-Mechanism of Injury & Nature of Illness

 

• The patient meets the mechanism of injury or nature of illness below and has at least two physiological parameters, the request may be made.

 

• For blood administration request, patients must be > 5 years of age with:

 

• • Signs of massive hemorrhage
  • Traumatic injury (penetrating or blunt)
  • Suspected dissecting/rupturing aneurysm (abdominal or thoracic)
  • Gastrointestinal bleeding
  • Signs of intra-abdominal bleeding

 

• Physiological parameters

 

• • Systolic BP < 90 mm HG
  • Heart rate > 120 bpm
  • Shock Index (SI) > 1
  • Shock Index is calculated by the following:
    • SI = Heart rate divided by systolic BP
  • Pediatric patients > 5 years of age whose vital signs are consistent with blood loss as defined by their weight or age-based parameters in the Pediatric Multiple Trauma Protocol

 

Personnel Requirements for Activation

 

1. Any GCEMS employee present at the scene of an injury or medical condition, and after an initial patient assessment may request this service.
2. The Medical Director, Operations Supervisor or any other administrative personnel may make the request prior to patient assessment if the mechanism of injury or patient's condition reflects the potential for blood administration.

 

Personnel Requirements for Deactivation

 

1. GCEMS paramedic after patient evaluation
2. Operations Supervisor or administrative personnel at any time
3. The Medical Director or on-line medical control at any time.

 

Procedure

 

1. After patient assessment and determining blood products will be needed, notify MedCom, MedCom will coordinate with Prisma Health and will report back details of response and an ETA.
2. Continue your assessment and treatment of the patient until the responding Prisma Health arrives at the scene.

 

Note: At no time should a GCEMS ambulance remain on the scene and not initiate emergent transport to the appropriate medical facility. If transport has been initiated prior to Prisma Health Ambulance Service arrival, they may intercept prior to hospital arrival.

 

Patient Preparation

 

GCEMS personnel will follow departmental guidelines regarding care for trauma patients; however, the following will be included for patients where blood products are to be administered:

 

• The patient is fully exposed when applicable per protocol
• The patients airway is intact and managed by ensuring the following:
  • Patient alert and following commands
  • Advanced airway in place with confiratmion of CO2 waveform.
• Hypoxia has been corrected
  • Patient is on supplemental oxygen
  • Goal of oxygen saturation greater than 94%
• External bleeding is controlled
  • All major injuries with bleeding have been addressed
  • Tourniquet placed for hemorrhage not controlled with pressure
• IV/IO access is placed, functional, and not infiltrated
  • Patient has 2 IV/IO sites
    • Adult 18g IV minimum
    • Pediatric 20g IV minimum
• The patient is covered with a blanket

 

IF GCEMS personnel can assist in having these items done prior to arrival as appropriate this will streamline the checklist process and help get blood products on board faster while transport is being facilitated.

 

Note: While Greenville County EMS personnel will always be ultimately responsible for all patient care activities, the Prisma Health paramedic will be responsible for transfusion administration and related reactions should they occur. The expectation is that our organizations will work together as a team to provide quality patient care.