By Stephen Wood
The State of Massachusetts is currently reviewing a new protocol for the pre-hospital (i.e., ambulance) administration of blood products to patients with acute hemorrhagic shock.
In the pre-hospital setting, hemorrhagic shock, which is characterized by rapid blood loss that results in potentially fatal oxygen depletion of the vital organs, is traditionally managed by the administration of intravenous fluids. But there is a growing body of evidence spanning several decades that this is not beneficial and, in fact, can be harmful.
In the hospital setting, blood loss is treated by replacing blood, most commonly in the form of packed red blood cells, plasma, and platelets. There is strong data supporting the use of replacement blood products for the management of life-threatening hemorrhagic shock, specifically a reduction in all-cause mortality. Moreover, research has demonstrated the safety, efficacy, and feasibility of pre-hospital blood transfusion. Several states have implemented protocols for pre-hospital blood administration based on this supporting data. There are barriers, however, to initiating this practice at several regulatory and non-regulatory levels. The result is that access to a potentially life-saving intervention is inequitably distributed.
