{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T10:47:54Z","timestamp":1794394074102,"version":"4.9.0"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X23005952_as1\"><jats:title>Introduction:<\/jats:title><jats:p>In far-forward combat situations, the military challenged dogma by using whole blood transfusions (WBTs) rather than component-based therapy. More recently, some trauma centers have initiated WBT programs with reported success. There are a few Emergency Medical Service (EMS) systems that are using WBTs, but the vast majority are not. Given the increasing data supporting the use of WBTs in the prehospital setting, more EMS systems are likely to consider or begin WBT programs in the future.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X23005952_as2\"><jats:title>Objective:<\/jats:title><jats:p>A prehospital WBT program was recently implemented in Palm Beach County, Florida (USA). This report will discuss how the program was implemented, the obstacles faced, and the initial results.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X23005952_as3\"><jats:title>Methods:<\/jats:title><jats:p>This report describes the process by which a prehospital WBT program was implemented by Palm Beach County Fire Rescue and the outcomes of the initial case series of patients who received WBTs in this system. Efforts to initiate the prehospital WBT program for this system began in 2018. The program had several obstacles to overcome, with one of the major obstacles being the legal team\u2019s perception of potential liability that might occur with a new prehospital blood transfusion program. This obstacle was overcome through education of local elected officials regarding the latest scientific evidence in favor of prehospital WBTs with potential life-saving benefits to the community. After moving past this hurdle, the program went live on July 6, 2022. The initial indications for transfusion of cold-stored, low titer, leukoreduced O+ whole blood in the prehospital setting included traumatic injuries with systolic blood pressure (SBP) &lt; 70mmHg or SBP &lt; 90mmHg plus heart rate (HR) &gt; 110 beats per minute.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X23005952_as4\"><jats:title>Findings:<\/jats:title><jats:p>From the date of onset through December 31, 2022, Palm Beach County Fire Rescue transported a total of 881 trauma activation patients, with 20 (2.3%) receiving WBT. Overall, nine (45%) of the patients who had received WBTs so far remain alive. No adverse events related to transfusion were identified following WBT administration. A total of 18 units of whole blood reached expiration of the unit\u2019s shelf life prior to transfusion.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X23005952_as5\"><jats:title>Conclusion:<\/jats:title><jats:p>Despite a number of logistical and legal obstacles, Palm Beach County Fire Rescue successfully implemented a prehospital WBT program. Other EMS systems that are considering a prehospital WBT program should review the included protocol and the barriers to implementation that were faced.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x23005952","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T10:21:46Z","timestamp":1687774906000},"page":"513-517","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":19,"title":["The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results"],"prefix":"10.1017","volume":"38","author":[{"given":"Charles","family":"Coyle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4357-6611","authenticated-orcid":false,"given":"Tony","family":"Zitek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E.","family":"Pepe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madonna","family":"Stotsenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A.","family":"Scheppke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Antevy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Giroux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Farcy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"key":"S1049023X23005952_ref7","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2019-209040"},{"key":"S1049023X23005952_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002471"},{"key":"S1049023X23005952_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2017.08.009"},{"key":"S1049023X23005952_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.12.073"},{"key":"S1049023X23005952_ref4","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1055\/s-0040-1702174","article-title":"Whole blood for civilian urban trauma resuscitation: historical, present, and future considerations","volume":"46","author":"Walsh","year":"2020","journal-title":"Semin Thromb Hemost."},{"key":"S1049023X23005952_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2017.06.002"},{"key":"S1049023X23005952_ref3","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1055\/s-0039-3402426","article-title":"The evolution of blood transfusion in the trauma patient: whole blood has come full circle","volume":"46","author":"Black","year":"2020","journal-title":"Semin Thromb Hemost."},{"key":"S1049023X23005952_ref1","first-page":"S69","article-title":"Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries","volume":"66","author":"Spinella","year":"2009","journal-title":"J Trauma."},{"key":"S1049023X23005952_ref13","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001905"},{"key":"S1049023X23005952_ref19","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew328"},{"key":"S1049023X23005952_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16528"},{"key":"S1049023X23005952_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(17)30051-0"},{"key":"S1049023X23005952_ref26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2010.02772.x"},{"key":"S1049023X23005952_ref15","doi-asserted-by":"publisher","DOI":"10.1111\/trf.14474"},{"key":"S1049023X23005952_ref11","doi-asserted-by":"publisher","DOI":"10.1159\/000519676"},{"key":"S1049023X23005952_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2019.03.012"},{"key":"S1049023X23005952_ref12","doi-asserted-by":"publisher","DOI":"10.1159\/000519623"},{"key":"S1049023X23005952_ref5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/SHK.0000000000001685","article-title":"Back to the future: whole blood resuscitation of the severely injured trauma patient","volume":"56","author":"McCoy","year":"2021","journal-title":"Shock."},{"key":"S1049023X23005952_ref8","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000086"},{"key":"S1049023X23005952_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.amj.2022.05.003"},{"key":"S1049023X23005952_ref2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31817e2ef9"},{"key":"S1049023X23005952_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.10.095"},{"key":"S1049023X23005952_ref23","unstructured":"23. 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