The Southwest Texas Regional Advisory Council (STRAC) is leading a multi-agency system in pioneering the use of whole blood for prehospital transfusions for trauma patients and those in hemorrhagic shock. The system includes the local blood bank, South Texas Blood and Tissue Center, the San Antonio Fire Department (SAFD) and the local trauma center, University Hospital.
Most civilian emergency medical services (EMS) providers in the United States use only isotonic IV solutions to treat a hemorrhage or trauma patient until the patient arrives at a trauma center and can receive a blood transfusion. These solutions usually contain only sodium chloride (Normal Saline) or lactated Ringer's solution. Some medical flight programs may use packed red blood cells and other blood components for transfusions, but even for these programs, use of whole blood is not common.
Since it began in 2018, STRAC’s Regional Whole Blood Program has established a growing body of evidence that transfusions using whole blood are not only feasible in a prehospital setting, but they also lead to better patient outcomes.
Features contributing to the program's success include:
- Careful stewardship of blood. Blood units are shared among participating agencies with the goal of all blood being used where it is needed most before its expiration date.
- The use of Low Titer O Positive Whole Blood (LTO+WB). Blood of type O positive is much more common in the population than the “universal donor” type O negative. While not as ideal for emergency transfusion as O negative, donated O positive blood can be prepared so it has very low concentrations of the antibodies and proteins that may trigger immune reactions in patients.
- Use of validated technology for cooling and warming whole blood originally developed for military medicine on the battlefield.
Learn more about STRAC’s Regional Whole Blood Program and the role of the SAFD within this program:
- STRAC's Regional Whole Blood Program website.
- SAFD's Position Statement for the Management of Patients in Hemorrhagic Shock.
- A June 2022 update on STRAC’s program in TRANSFUSION, the Journal of the Association for Advancement of Blood and Biotherapies (AABB).
STRAC's National Whole Blood Academy provides training to those interested in starting similar whole blood programs and the SAFD offers information on its program through lectures and conference engagements.
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