A prehospital scoring system for predicting the need for emergent blood product transfusion

Blood Product Administration in the Prehospital Setting: A Scoping Review

OBJECTIVES

Implementing prehospital blood products for treating hemorrhagic shock has been utilized globally in military and civilian settings. This review aims to compare various guidelines for using blood products, including the types of blood products, injuries, biomarkers (hemodynamic measurement) to indicate use, associated treatments and risks, and the logistical concerns of storage and wastage in the prehospital setting. Furthermore, it explores whether prehospital blood transfusions are beneficial and a safe treatment option.

METHODS

Data were collected using a systematic search and screening process of online databases CINAHL, Medline, and Scopus, as well as by creating a PRISMA flow diagram to screen articles using inclusion and exclusion criteria. Forty-five articles were screened, with twenty-five excluded, resulting in twenty articles in this scoping review.

RESULTS

The most frequently used blood product used was red blood cells, with twelve studies using either red blood cells alone or in combination with other products. Indications for blood use varied across services, but all aimed to address hemodynamic instability as a primary indication for blood transfusion. Eleven studies recorded no adverse reactions. Only one study reported chills and shivers; however, it was unclear if blood products were the cause. Nine studies avoided logistical issues of storage and wastage to create a feasible rotation system.

CONCLUSIONS

Prehospital blood was used in medical, trauma, and maternity-related hemorrhage. Many types of blood products are in use, ranging from component therapy to whole blood, with each protocol having different indications of use and treatment guidelines aimed at improving hemodynamic stability.

Implications for future humanitarian aid missions: Lessons from point-of injury and hospital care for Syrian refugees

BACKGROUND

Warzone humanitarian medical aid missions are infrequent and applying lessons from these missions is vital to ensuring preparedness for future crises. Between 2013-2018, the Israel Defense Forces Medical Corps (IDF-MC) provided humanitarian medical aid to individuals injured in the Syrian Civil War who chose to seek medical assistance at the Israeli-Syrian border. Patients requiring care surgical or advanced care were transferred to civilian medical centers within Israel. This study aims to describe the injury characteristics and management of hospitalized Syrian Civil War trauma patients over a five-year period.

METHODS

Retrospective cohort analysis cross-referencing data from the IDF trauma registry, documenting prehospital care, and the Israel National Trauma Registry, documenting in-hospital care, between 2013 and 2018. Syrian trauma patients hospitalized in Israeli hospitals were cross-referenced between the two registries. Multivariable logistic regression was applied to identify independent factors associated with in-hospital mortality.

RESULTS

Overall, 856 hospitalized trauma patients were included following definitive cross-matching. The median age was 23 years, and 93.3% were males. Blast (n = 532; 62.1%) and gunshot (n = 241; 28.2%) were the most common injury mechanisms. Injury Severity Score was ≥25 for 28.8% of patients and most common body regions with severe injury (Abbreviated Injury Scale≥3) were the head (30.7%) and thorax (25.0%). Intensive care unit admission was required for 40.1% of patients, and the median hospital stay was 13 days. In-hospital mortality was recorded for 73 (8.5%). Signs of shock upon emergency department admission and severe head injury were significantly associated with mortality in the adjusted model whereas age of <18 years was associated with decreased odds for in-hospital mortality.

CONCLUSIONS

Trauma patients hospitalized in Israel following injuries sustained in the Syrian Civil War were characterized by a high prevalence of blast injuries with concomitant involvement of several body regions. Future missions should ensure preparedness for complex multi-trauma, often involving the head, and ensure high intensive care and surgical capacities.