Transfusion Protocol

Question 1

Transfusion Information

Answer 1

In general, one-unit 500mL (1 unit) of Low Titer O+ Whole Blood (LTO+WB) will be available per patient.
Of Note: At this time the LTO+WB does not have volume markings on the bag.

Question 2

Transfusion Conformation Procedure

Answer 2

1) Confirm patent administration site if any question exists utilize a new site
2) Identify the patient meets criteria above
3) Record baseline vitals
4) Two EMS personnel must confirm the tag and the blood product match including number, blood type, Rh factor, expiration date and fluid amount
5) Both confirming personnel must sign the accompanying blood component tag

Question 3

Transfusion Administration

Answer 3

1) Place flat thermometer on patient’s forehead.
2) Whole Blood 1 unit IV/IO via blood Y-tubing. Flow through blood warmer to completion and / or hemodynamic stability. Repeat PRN x 1. Utilize low titer O+ for most patients
3) Adult: 1-2 units of Whole Blood, repeat as needed
4) Pediatric > 5 years of age (No evidence of Puberty): 15ml/kg of Whole Blood,
repeat as needed
5) In the event Whole Blood is not available, Low Titer Liquid Plasma or O+ PRBC may be given as a substitute for hemodynamic instability. Repeat PRN x 1.

Question 4

Transfusion Documentation

Answer 4

• Document administration in the flow chart section, currently the only option is blood, please indicate the type and volume. In the narrative, please describe the reason for blood, what products where used, Patients Temperature Before, During and After administration, response to blood products, Qin Flow warmer was used, any adverse reactions, patient or family consulted about blood
  products and if medical director contact was made.

Question 5

Transfusion Contraindication

Answer 5

▪ Religious objection to receiving blood products
▪ Woman of Childbearing Age should have confirmed Hemorrhagic Shock

Relative Contraindications
▪ Patient < 5 years old
Consult Medical Direction if patient is in hemorrhagic shock and < 5 y/o

Question 6

Signs of acute Hemorrhagic Shock

Answer 6

1) Systolic Blood Pressure < 70 mmHg OR
2) Systolic Blood Pressure < 90 mmHg with- Heart Rate ≥ 110 beats per min OR
3) Age ≥ 65 y/o and SBP ≤ 100 AND HR ≥ 100 beats per minute ( Shock Index=1) OR
4) Witnessed traumatic arrest and < 5 min total continuous CPR during downtime
5) ETCO2 < 25 (Consider as early shock indicator)
6) Paramedic Judgment (Except in women of childbearing age, in these patients document their signs of decompensation)

Question 7

How to calculate Shock Index

Answer 7

Heart Rate/ Systolic Blood Pressure