Prehospital Blood: If Your Truck Carries It
Objective: Know when prehospital blood is for (life-threatening traumatic bleed with shock physiology), what product is preferred, and that it never replaces a tourniquet or a short scene.
Why This Is Hard
Most trucks still do not carry blood. The ones that do sometimes give it late, after a liter of saline, or instead of a tourniquet. NAEMSP 2025 trauma compendium: in systems that can support a quality program, blood products over crystalloid for life-threatening traumatic bleeding, and low-titer group O whole blood as first choice. ACEP: blood must not delay hemorrhage control or transport. If you do not carry it, this lesson is still the crystalloid-restraint lesson.
- MARCH first. Tourniquet, packing, pelvic binder, wound that is actually held. Blood on a still-squirting femoral is theater.
- Indications are physiologic plus pattern: hypotension, shock index, obvious massive loss — not “they look pale.”
- Monitor for transfusion reaction. Handoff the product, time, volume, and any reaction. Warm if your system warms.
Street Sequence
- Stop compressible hemorrhage. Airway. Breathe. Then the cooler.
- Access that will actually flow (large IV or humeral IO). TXA per protocol is not a blood substitute.
- Transfuse per protocol. Reassess. Do not chase a normal BP in penetrating torso trauma — DCR still applies.
- Destination trauma center. Unused product handling is a system problem — do not dump a unit “because we are almost there” without a protocol reason.
Field Rules (Education)
- Blood over crystalloid for life-threatening traumatic bleed when a program exists. Big saline worsens coagulopathy.
- LTOWB first when available. Component therapy is a second choice, not a reason to withhold.
- No blood on the truck still means restrained crystalloid, TXA if indicated, and a fast trauma center — see DCR.
- Vasopressors in hemorrhagic trauma are not the NAEMSP recommendation. Squeeze is not a substitute for volume that is on the floor.
- Bleed is controlled — then blood if we carry it
- Indication is shock physiology plus pattern
- Whole blood if that is the program product
- Not replacing the tourniquet with a unit
Field Pitfalls
- A unit of blood while the femoral is still open.
- A liter of saline first “to see if they perk up.”
- Push-dose epi for hemorrhagic shock because the BP was low.
Practice
60-second drill
GSW thigh, tourniquet on, BP 72, your truck has LTOWB. Order of actions. Then: same patient, no blood on the truck. What still happens, and what does not?
Related: Damage-Control Resuscitation, Tranexamic Acid in Trauma.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- NAEMSP 2025 Prehospital Trauma Compendium: Transfusion of Blood Products — blood over crystalloid; low-titer O whole blood first-choice when a quality program exists
- ACEP prehospital blood in hemorrhagic shock — blood must not delay hemorrhage control or transport
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.