Pre-Hospital Whole Blood – What It is & Why It Matters?

Whole Blood

In nearly two decades of working with EMS, Lieutenant Kenneth Pippin has seen many meaningful changes in the industry. However, whole blood transfusions stand out as the most significant of all. “Low-titer O Whole Blood (LTOWB) transfusions are the greatest life-saving change I have witnessed in EMS. Its efficacy in treating patients with hemorrhagic shock is widely acknowledged,” Pippin stated.

Whole blood refers to administering blood to patients in a pre-hospital setting, such as an accident scene or ambulance. The procedure can be performed with stored bags of donated O-positive blood – instead of blood components like plasma or platelets. The International Association of EMS Chiefs (IAEMSC) strongly endorse the practice.

Despite its well-known benefits, pre-hospital whole blood is not a common practice in the U.S. Currently, 99% of rescue services don’t stock their ground ambulances and helicopters with blood. Instead, the standard care nationwide for stabilizing trauma patients involves administering Crystalloids, an intravenous water solution with electrolytes. As a result, thousands of people bleed out from injuries every year. “Hemorrhage remains the primary cause of preventable death in trauma patients,” Pippin emphasizes.

Whole Blood Obstacles

According to Pippin, the logistical challenges and costs associated with deploying whole blood have prevented its expansion beyond Trauma Centers. Logistical factors include proper storage with temperature control, inventory management, staff training, and protocols.

Additionally, there are no reimbursement practices regarding whole blood and pre-hospital settings. Neither governmental payers nor private insurance reimburses EMS providers for blood transfusions en route to a hospital.

Texan Initiative

Lt. Pippin speaking about STRAC LTOWB program at Education By The Sea

EMS Providers in the San Antonio region are ahead of the curve. Lieutenant Pippin’s agency, the New Braunfels Fire Department – an EMERGICON partner – is a major player in the STRAC LTOWB program. “Through collaborative efforts between the Southwest Texas Regional Advisory Council, hospitals, and EMS agencies in the area, the logistic and cost hurdles for pre-hospital whole blood have been overcome,” Pippin explains. 

Data shows that, since the program’s start in 2018, hemorrhagic trauma mortality rates have decreased by an estimated 50%. “This regional approach to Pre-Hospital LTOWB transfusions is an example that could be replicated throughout the country,” he affirms.

Local providers can join the program by contacting STRAC here.

EMERGICON’s network of EMS agencies includes providers who administer pre-hospital whole blood. To learn more about their work, contact EMERGICON’s EMS & Client Hotline: 866-839-3671 |

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