Emergency Whole Blood Transfusions Now Available from Mon EMS

• Monongalia EMS (Mon EMS) will officially launch its Whole Blood Program on May 1, 2025. Mon EMS will become the third EMS agency in WV (following Cabell and Harrison) to offer this service to our patients. Of the three agencies that offer whole blood, Mon EMS serves the highest population. Mon EMS will join less than 100 EMS/fire services nationwide to utilize whole blood in pre-hospital care.  
   
• Between 2020-2023 there were 1.2 million trauma patients who were potentially eligible for prehospital blood transfusion, yet less than 1% received this intervention due to few EMS/fire having blood available. Peak time of death for patients who are hemmhoraging is 30 minutes. Research shows that it takes on average 74-88 minutes from 911 call for a patient to get into an Operating Room. Thus, it is vital that the patient receives blood in the prehospital setting.
   
• Many EMS agencies only train a few paramedics to administer blood. Mon EMS made the decision and investment to train all 60 of our paramedics. This greatly enhances our ability to ensure that patients, no matter where they live in the county, have access to this critical care. Blood is especially life saving to our residents in the rural areas of the county, who are further away from the trauma center.
   
• Low Titer Type O+ Whole Blood which has been shown to be safe for patients of all ages and blood types, including children and pregnant women. Low Titer Type O+ Whole Blood is a U.S. Food and Drug Administration (FDA) and Association for the Advancement of Blood & Biotherapies (AABB) approved blood product for transfusion to critically ill and injured patients whose blood type is unknown.
   
• Whole blood will be given as a lifesaving measure to patients, in critical condition, who have sustained significant blood loss through suspected traumatic injury or bleeding from medical reasons (i.e. gastrointestinal bleed) in compliance with West Virginia Statewide Pre-Hospital Protocolsd,.
   
• “Whole blood” contains all blood components – including red blood cells, plasma, and platelets. When a patient is bleeding profusely, they lose all of these components – and all three of these components can be replaced by transfusing whole blood.  All whole blood that is administered is low in titer level of anti-A and anti-B antibodies, making it safer for administration and less likely for a transfusion reaction to occur. Reactions are extremely rare, with the likelihood of 1 in 40,000 patients having a reaction.
• Mon EMS will obtain whole blood for the program through a partnership with the WVU Blood Bank. To prevent waste, the blood will be exchanged weekly, so that it can go into circulation at the hospital and be used long before it expires. Mon EMS will host community blood drives as a campaign to increase blood donations within Monongalia County.
   
• For unresponsive patients, clinicians are trained to check for relevant medical identification and alert tags that could indicate a patient’s objection to receiving blood. A conscious patient can refuse a blood transfusion at any time.
   
• Neighboring EMS agencies who are enroute to WVU Ruby Memorial Hospital with a critical patient in need of blood can request Mon EMS to rendezvous with them and administer blood to their patient.

FAQs

What blood type do you administer?

Mon EMS administers Low Titer Type O+ Whole Blood (LTO+WB). Here’s why:

• Low Titer: Contains low levels of antibodies, making it safe to transfuse to a patient with any blood type.
• Type O+: Type O blood is known as the universal donor, meaning it can be transfused to any patient. O positive blood is much more commonly available than O negative. Only 7% of the U.S. population has O- blood type, compared to 37% who are O+. 
• Whole Blood: Contains all blood components (red blood cells, plasma, and platelets) in one product.

LTO+WB is an FDA-licensed and American Association of Blood and Biotherapies (AABB)-approved blood product for emergency release in life-threatening situations where blood is needed immediately, and the patient's blood type is unknown. It is in use at West Virginia University Ruby Memorial Hospital, and more than 100 other trauma centers in the U.S.

Whole Blood is superior to standard component blood [TC1]  therapy – standard 1:1:1 ratio of Packed Red Blood Cells (PRBCs) – Fresh Frozen Plasma (FFP)[TC2] – Platelets are more diluted, reducing your overall oxygen carrying capacity, contain fewer clotting factors, and have higher amounts of additives such as citrate.[i]

What is the Whole Blood Program, and who is eligible?

The Whole Blood Program allows specially trained Mon EMS paramedics to administer whole blood transfusions to patients who have sustained significant blood loss through suspected traumatic injury and/or internal bleeding.

Prehospital whole blood may be administered to select patients >1 year of age with significant bleeding (traumatic, obstetric, gastrointestinal, etc.) and signs of hemorrhagic shock. To determine eligibility for the Whole Blood Program, Mon EMS clinicians follow West Virginia Statewide Pre-Hospital Protocols, issued annually by the West Virginia Office of EMS (WVOEMS). Whole blood is safe for administration to patients of all ages and blood types, including children and pregnant women.

Why do field blood transfusions matter?

The timely administration of whole blood to a patient with significant blood loss is an essential step in increasing survivability. In injuries with high volumes of blood loss, some of the best medicine we can provide for our patients is stopping the bleed and/or replacing the blood they’ve lost from their injury and getting them to the hospital.

A growing body of data shows better outcomes for patients who receive blood in the field, prior to arriving at the hospital. Evidence suggests early whole blood administration (less than 35 minutes from injury) in severely injured trauma patients can increase survivability.[ii] EMS crews can get the blood on board sooner than waiting to get to the hospital, which improves outcomes.[iii]

A 2022 study in the Journal of American College of Surgeons determined that Whole blood increased 30-day survival by 60% and reduced the need for 24-hour blood products by 7%.[iv] Prehospital whole blood is permitted by the AABB (American Association of Blood Banks) standards.[v]

How is it made?

Blood is collected from volunteer donors, screened for disease, and verified to have non-significant levels (low titers) of antibodies against Type A or B blood. White Blood Cells are filtered out, but the blood is left whole with plasma and platelets to promote clotting and red blood cells to carry oxygen.

Can patients refuse or opt out of the Whole Blood Program?

Conscious patients can refuse a blood transfusion at any time. For unconscious patients, providers will check for relevant medical identification, including alert tags, for any patient directives before issuing whole blood.

Are whole blood transfusions safe?[TC3] 

Whole Blood transfusions have been utilized as far back as 1917. Whole Blood was frequently used during World War Two. In 1952 over 60,000 units of Low Titer Whole Blood were administered to soldiers in the Korean War with no serious reactions.[vi]

Whole Blood is Safe – All blood administered is low in titer level of anti-A and anti-B antibodies, [TC4] making it safer for administration and less likely for a transfusion reaction to occur. Prehospital administration of whole blood is being utilized safely in dozens of EMS systems throughout the country and nearly half of trauma centers. Adverse severe reactions are rare.

Is it safe to give Rh+ blood to patients who are Rh-?

Most agree that the risk of imminent death strongly shifts the risk/benefit consideration in favor of RH- patients receiving RH+ blood.[vii] The risk of complications is considered to be very low.

What about women of childbearing age who are Rh-?

The risk of the patient's imminent death favors the administration of LTO+WB. The risk of a possible significant impairment of a fetus in a future pregnancy is estimated by some to be 0.4%.[viii]

Is whole blood safe for children?

Yes[ix]^,[x]  

Does this interfere with the administration of other blood products or medication?

No; ABO/Rh typing is accurate up to 10 units of group O RBCs or LTOWB. The early collection of a type and screen sample is important.[xi]

Can patients who receive LTO+WB get additional medication or blood products at the hospital?

Yes.

What if patient has a transfusion reaction after being dropped off at the hospital?

Prehospital transfusion reactions are rare but remain a possibility. EMS clinicians will treat accordingly, including the administration of medications. The blood bank and the EMS program that transported the patient will coordinate with the receiving hospital. In addition, the EMS crew will leave the blood tubing, which should be sent for testing.