Barriers to prehospital whole blood implementation

In this episode of EMS One-Stop, host Rob Lawrence is joined by Dr. Christine Carico and Dr. Matt Levy to discuss the peer-reviewed paper, “Nationwide Trends in Prehospital Blood Product Use After Injury.” The paper, published in “Transfusion” in April 2025, explores the use of blood products in prehospital trauma care. Despite the proven benefits of blood transfusion in the field, their research uncovers the alarming reality that less than 1% of eligible patients receive prehospital blood products. This conversation dives into the study’s methodology, key findings and the significant barriers EMS systems face in implementing blood transfusion protocols. The discussion also touches on the evolving role of EMS in trauma care, regional variations in blood product access, and the future of prehospital blood transfusion programs. Dr. Carico and Dr. Levy break down their work and reflect on the data, explaining how the study used National Emergency Medical Services Information System (NEMSIS) data to identify trauma patients who would have benefited from blood transfusions. The episode delves into the operational challenges EMS systems face in obtaining and administering blood products in the field, the financial and logistical obstacles, and the potential life-saving impact of more widespread adoption of these protocols. Timeline 00:00 – Intro and welcome: Rob Lawrence introduces Dr. Matt Levy and Dr. Christine Carico, setting up the discussion on prehospital blood product use 03:00 – Study overview: Dr. Carico explains the methodology of the study, focusing on the use of NEMSIS data and the inclusion criteria for the patient population 07:00 – Key findings: Dr. Carico reveals the key findings of the paper, including the low percentage of eligible patients receiving prehospital blood products 11:00 – Barriers to implementation: Dr. Levy discusses the main barriers to the widespread implementation of blood transfusion protocols in the field, including access to blood, logistics and training 17:00 – Regional variations: The speakers touch on the regional disparities in blood product availability and the differences in protocols across the country 23:00 – Data challenges: Dr. Levy and Dr. Carico discuss the challenges related to data accuracy, particularly in terms of blood product documentation 27:00 – Cost and reimbursement: Dr. Levy addresses the financial aspects of blood product programs, including cost, reimbursement challenges and funding opportunities 32:00 – The future of blood transfusion in EMS: Dr. Levy envisions the future of prehospital blood transfusion programs, including the potential for shelf-stable blood products and regional blood supply systems 37:00 – Closing thoughts: Both guests offer their final thoughts on the importance of continued research and data collection, and the need for EMS to embrace a more integrated role in acute care Additional whole blood resources Carico C, Annesi C, Clay Mann N, Levy MJ, et al. “Nationwide trends in prehospital blood product use after injury,” 2025. Transfusion – Wiley Online Library Tracking the whole blood landscape as updated guidelines allow EMS to carry and administer whole blood EMS One-Stop: Stop the bleed, fill the tank – The New Orleans EMS blood program Insider analysis: Delaware’s statewide whole blood rollout sets a new EMS standard Whole blood in EMS promises a revolution in resuscitation: How one county agency is saving lives with prehospital transfusions Matthew Levy | LinkedIn Christine Carico | LinkedIn