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Epidemiological and Accounting Analysis of Ground Ambulance Whole Blood Transfusion

Published online by Cambridge University Press:  18 December 2019

Julian G. Mapp Open the ORCID record for Julian G. Mapp [Opens in a new window] ,
Eric A. Bank ,
Lesley A. Osborn ,
Michael L. Stringfellow ,
David W. Reininger ,
Christopher J. Winckler  and
Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME2) Group
Julian G. Mapp*
Affiliation:
US Army Institute of Surgical Research, JBSA Fort Sam Houston, TexasUSA Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
Eric A. Bank
Affiliation:
Harris County Emergency Service District 48 Fire Department, Katy, TexasUSA
Lesley A. Osborn
Affiliation:
Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TexasUSA
Michael L. Stringfellow
Affiliation:
San Antonio Fire Department, San Antonio, TexasUSA
David W. Reininger
Affiliation:
Harris County Emergency Service District 48 Fire Department, Katy, TexasUSA
Christopher J. Winckler
Affiliation:
Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
*
Julian G. Mapp, MD, MBA, MPH Department of Emergency Health Sciences University of Texas Health Science Center at San AntonioSan Antonio, Texas78229USA E-mail: jmappmd@gmail.com
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Abstract

Introduction:

In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs.

Methods:

The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative.

Results:

Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS.

Conclusion:

This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.

Keywords

epidemiologyprehospital transfusionwhole blood
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 98 - 103
Copyright
© World Association for Disaster and Emergency Medicine 2019

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