By Nicholas P. Cozzi, MD, MBA, FACEP, FAEMS; Physician Advisor, Hinckley Medical, Inc.
A Step Forward for EMS Medicine
The recent Clinical Practice Guideline (CPG) for Prehospital Blood Transfusion released by the Prehospital Blood Transfusion Coalition represents a watershed moment in out-of-hospital medicine. As someone deeply engaged in EMS operations across urban and regional systems, I view this document not only as a roadmap for safe and scalable implementation but as a declaration: pre-hospital blood transfusion is here, it is safe and effective, and it is saving lives.
This guideline was built for practicality—distilling complex inpatient transfusion protocols into a digestible, actionable framework tailored for EMS. From recognition of hemorrhagic shock to product selection and documentation, every section prioritizes what matters most: saving lives.
Critical Principles that Shape Modern Prehospital Resuscitation
The guideline reinforces several foundational principles that are essential for successful prehospital transfusion:
- Early Recognition of Shock using tools like shock index and ETCO₂.
- Minimizing Crystalloids to prevent dilutional coagulopathy.
- Permissive Hypotension as a default strategy, except in cases of suspected traumatic brain injury.
- Whole Blood or Balanced Component Therapy when whole blood is not available.
- TXA Administration within 3 hours of injury, a practice that should be second nature for all EMS systems at this point.
It also outlines essential equipment (coolers, warmers, filters), clear documentation standards, and quality assurance expectations that align well with broader medical control and CQI goals.
Weight-Based Dosing: A Defining Feature in Pediatric Trauma Care
One of the most commendable aspects of the guideline is its firm stance on weight-based dosing for pediatric patients—a point that deserves strong reinforcement across all EMS protocols, not just transfusion.
- For TXA, the guideline calls for 15 mg/kg IV over 10 minutes, followed by a 2 mg/kg/h infusion—a vital dose that cannot safely be approximated by age or general appearance.
- Calcium replacement is also weight-based: 20 mg/kg of calcium chloride or 60 mg/kg of calcium gluconate, administered slowly.
- Transfusion volumes are specific and appropriate: 10 mL/kg for children under 35 kg, and a single unit for children over that threshold.
This approach is not just clinically accurate—it’s a critical tool in reducing dosing errors and EMS clinician liability while enhancing patient safety. When lives are on the line, rounding or guessing isn’t enough. That’s why weight-based precision must be the standard, and why technologies like OneDose and OneWeight play such a vital role in ensuring safe, point-of-care decision-making.
Why These Guidelines Matter—Even for Systems Without Blood Yet
Even if your EMS agency isn’t yet equipped for prehospital blood, this document is still essential reading. It frames the future of EMS, where hemorrhage control, resuscitation, and early pharmacologic intervention are part of routine field care.
Medical directors, educators, and EMS leaders should use this CPG as both a planning tool and a clinical compass. It provides a framework for justifying investments, developing protocols, and training teams with the kind of clarity we don’t often see in the early adoption phase of major clinical changes.
What We’re Doing at Hinckley Medical
At Hinckley Medical, these guidelines reinforce why our mission is so important. Protocol adherence and weight-based dosing are the backbone of safe prehospital care, and our tools are designed to support medics—especially in the highest-risk, lowest-frequency scenarios like pediatric trauma or OB hemorrhage.
OneDose enables fast, filtered access to medications like TXA and calcium, with age and weight-based calculators embedded directly into each agency’s protocols. Whether you’re transfusing blood in a helicopter or trying to remember the TXA dose for a 14 kg toddler on the side of the highway, OneDose is built to reduce stress and increase accuracy.
Conclusion
This guideline isn’t just a milestone for EMS—it’s a call to action. We must now ask: How will we ensure our EMS clinicians are ready? The Prehospital Blood Transfusion CPG helps answer that. Let’s continue building tools, protocols, and teams that meet this new standard—with the accuracy, agility, and support EMS clinicians deserve.
To read the full Clinical Practice Guideline, visit here. To learn more about how Hinckley Medical supports precision medicine in the field, visit www.hinckleymed.com.
Citation: Levy, M. J., Schaefer, R. M., Obyrne, H., Krohmer, J. R., Bank, E. A., & Holcomb, J. B. (2024). Clinical practice guideline (CPG) for prehospital blood transfusion. BMJ Military Health. https://doi.org/10.1136/military-2023-001931