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PR30: Out-of-Hospital Blood Administration

Applicable To

Introduction

Indications

• Traumatic injury and:
  • Early Blood Transfusion Needs (EBTN) score of ≥ 5; or
  • Active hemorrhage and hemoglobin < 70 g/L. 
    • Hemoglobin < 90 g/L in patients with symptoms of active acute coronary syndrome.
• Patient age ≥ 12.

Contraindications

• Refusal of blood product administration.
• Isolated penetrating head injury.

Procedure

1. Complete pre-transfusion bloodwork (group and screen, epoc® BGEM Test Card).
   • If clinically appropriate
2. Consider tranexamic acid.
3. Correct hypothermia.
   • Prevent further heat loss by using warmed IV fluids, chemical blanket, etc.
4. Consult with EPOS.
   • If EPOS is unavailable, consider contacting the receiving hospital directly.
   • Blood is not to be transfused without physician consultation.
5. Administer 1-4 units PRBCs to clinical response.
6. Declare TRANSFUSION to the receiving emergency department. 

Notes

Early Blood Transfusion Needs (EBTN) Score

Risk Factors	Score
Age (years) 0-55 56-70 > 70	0 1 2
Type of Injury Penetrating Non-penetrating	2 0
Pulse (beats/minute) < 60 60 - 119 > 120	-4 0 3
Systolic BP (mmHg) < 90 > 90	7 0
Glasgow Coma Scale 3 - 8 9 - 13 14 - 15	3 1 0

Resources

References