AABB Provides Feedback for Systematic Review of Prehospital Blood Transfusion

In response to a request by the National Highway Traffic Safety Administration’s Office of Emergency Medical Servies (EMS) and the Agency for Healthcare Research and Quality (AHRQ), AABB recently submitted feedback on the feasibility, effectiveness and safety of prehospital blood transfusion.

This systematic review, announced in May, aims to inform future clinical decision-making, guidelines and protocols for state and local EMS agencies by exploring key questions about the benefits and harms of low-titer group O whole blood transfusion, component therapy and fluid resuscitation. The review also sought feedback on how these benefits and harms are influenced by factors such as patient characteristics and EMS system characteristics.

AABB’s letter addressed several key areas of focus. First, it compared different blood transfusion methods, emphasizing the ongoing debate among experts about the benefits and challenges of low-titer group O whole blood and component blood therapy. AABB highlighted that additional research and comprehensive data are needed to fully evaluate these critical interventions.

AABB recommended a comprehensive gap analysis to define research questions; assess EMS capabilities and operational limitations; define the scope of training needed for EMS personnel to safely administer blood in prehospital settings; understand blood collectors’ operational limitations that may impact the availability of different interventions; evaluate the potential impact of prehospital transfusion programs on hospitals’ inventories; and study blood wastage and methods to limit it.

Additionally, AABB highlighted several barriers and facilitators to the implementation of effective prehospital blood transfusion programs, including reimbursement policies, operational challenges, and the need for standards and education. Current Medicare reimbursement policies and the resulting payment rates are insufficient to cover the costs of prehospital blood transfusions. AABB reiterated its recommendation that the Centers for Medicare and Medicaid Services establish a new model that includes adequate funding to support prehospital blood transfusions.

In addition, blood collectors must be positioned to support blood transfusion programs. AABB emphasized that addressing issues like donor recruitment, manufacturing constraints and supply chain limitations is also crucial for the success of prehospital transfusion programs.

Furthermore, AABB noted that some of the challenges associated with prehospital transfusion will be mitigated by the first edition of AABB’s Standards for Out-of-Hospital and Prehospital Administration Transfusion Services. When these standards take effect in 2025, they will support EMS providers in implementing safe transfusion practices.