The growing need for whole blood: Why it’s time for EMS to step up

“Trauma patients are dying because the systems we have in place aren’t designed to meet the demand for blood products in the field.”

May 12, 2025 02:25 PM

Blood bag in hand scientis. — Blood bag in hand scientis blood bank laboratory.

Bottom line up front

Prehospital whole blood facts

Hemorrhage is the leading cause of preventable death in trauma, and early blood transfusion can save lives
Between 260,000 and 1.2 million trauma patients annually could benefit from prehospital blood transfusions
Despite the high demand, less than 1% of eligible trauma patients received prehospital blood transfusions between 2020 and 2023

Prehospital whole blood takeaways

The need for prehospital blood transfusions is growing, but utilization remains alarmingly low
EMS agencies face significant barriers, including cost, lack of standardized protocols and reimbursement issues
The underuse of blood products in the field highlights a critical gap in trauma care that directly impacts patient survival

Prehospital whole blood next steps

Standardize national protocols for prehospital blood transfusion to ensure consistent application across EMS agencies
Increase funding and reimbursement to make blood products more accessible for EMS agencies
Improve blood product access, especially in underserved areas, and enhance data collection to track usage and demand

You don’t need me to tell you that hemorrhage, or severe bleeding, is the leading cause of preventable death in trauma patients. As EMS professionals, we all know how critical it is to stop the bleeding before it’s too late. Yet, despite a growing body of evidence that prehospital blood transfusions could save lives, less than 1% of eligible trauma patients actually receive this vital intervention. The latest study, “Nationwide Trends in Prehospital Blood Product Use After Injury,” confirms that the demand for prehospital blood transfusions is growing, but implementation is lagging.

|More: Barriers to prehospital whole blood implementation

The stark reality: A life-saving intervention left untapped

Published in “Transfusion” in April 2025, the study used data from the National Emergency Medical Services Information System (NEMSIS) from 2020 to 2023 to measure the potential demand for prehospital blood transfusion. What they found is both eye-opening and frustrating: between 260,000 and 1.2 million trauma patients annually could benefit from blood products in the field, yet only a fraction — less than 1% — actually receive them.

Trauma-induced hemorrhagic shock is a deadly condition, but early intervention with blood products can drastically improve outcomes. If you’re in the field, you know that trauma is all about timing. The faster we can stabilize patients with life-saving interventions, the better their chances of survival. But for too many patients, prehospital blood transfusions are still a rarity.

The roadblocks: Why are blood transfusions so rare in the field?

The answer is a combination of logistical, financial and policy-related barriers. While several EMS agencies, particularly in regions like Texas and North Carolina, have pioneered programs to carry blood products in the field, these efforts remain the exception rather than the rule. By 2024, only about 1% of EMS agencies nationwide were equipped to administer prehospital blood transfusions. For the vast majority of EMS providers, this resource simply isn’t available.

1. Cost and supply limitations

Blood products are expensive. The cost of providing a prehospital blood transfusion can run upwards of $1,000 per patient. Given that many EMS agencies, particularly in rural or volunteer settings, operate under tight budgets, it’s no surprise that the expense of blood products is a significant barrier to their use. Adding to this challenge is the fact that blood banks and hospitals are often the sole suppliers of blood for EMS agencies, placing additional strain on already stretched resources.

2. No standardized protocols

There’s no national standard for when EMS should administer blood transfusions. Although groups such as the Prehospital Blood Transfusion Coalition are spearheading efforts to develop such a standard, it’s currently up to each individual agency and provider to decide. This lack of consistency means that some agencies use blood products, while many others don’t — even though they could save lives with them. We need uniform guidelines to ensure blood products are used consistently across all EMS agencies, regardless of where they operate.

3. Reimbursement issues

Many EMS agencies aren’t reimbursed for prehospital blood transfusions, leaving them to foot the bill. This lack of financial incentive makes it even harder for agencies to justify carrying blood products. Moreover, EMS documentation practices are often not robust enough to capture blood product usage consistently, meaning some patients who receive transfusions in the field may not have their treatment properly recorded.

A growing need: The demand for prehospital blood is increasing

One thing the study makes abundantly clear is that the need for prehospital blood transfusions is only rising. In 2020, about 54,000 trauma patients met the criteria for needing blood, and by 2023, that number had jumped to 75,000 — a clear sign that this demand is growing. Meanwhile, the actual use of prehospital blood transfusions remained low, with only 0.64% of patients in 2020 and 0.88% in 2023 receiving them. That’s a frustratingly small increase considering the increasing number of patients who could benefit from this intervention.

As EMS professionals, we know that when someone’s bleeding out, every minute counts. So why aren’t we doing more to meet this growing demand?

Overcoming the barriers: A path forward for EMS

If we’re serious about saving more lives, we need to break down the barriers standing in the way of prehospital blood transfusion. Here’s how we can do it:

Standardize national protocols. We need a unified approach to prehospital blood transfusions. While every EMS agency should have the flexibility to make decisions based on their local context, we must develop national guidelines to help every provider make the right call. Blood products should be used when patients show clear signs of hemorrhagic shock — this isn’t a grey area.
Increase funding and reimbursement. This isn’t just a financial burden on EMS agencies — it’s a national issue. Congress and state governments need to step up and provide financial support to EMS agencies that are willing to carry blood products. Until there’s a clear pathway for reimbursement, the financial burden will remain a significant roadblock.
Expand blood product access. EMS agencies need easier access to blood products, especially in high-need areas. Partnering with regional blood banks and hospitals to ensure a steady and reliable supply of blood could be the key to making blood products available to more EMS agencies. This includes hosting and facilitating blood drives. Blood products shouldn’t be something that only certain regions have access to — they should be available wherever trauma patients need them.
Improve documentation and data reporting. Better documentation practices will ensure that the use of blood products is tracked more accurately. This data will help further refine protocols and demonstrate the impact of prehospital blood transfusions on patient outcomes.

The bottom line: We can’t afford to wait

The findings of this study are sobering, but they also provide us with a clear call to action. The potential to save lives with prehospital blood transfusions is high — but so is the unmet need. Trauma patients are dying because the systems we have in place aren’t designed to meet the demand for blood products in the field. The evidence is there, the need is clear, and the time to act is now.

EMS professionals are at the tip of the spear in trauma care. We are the first responders on the scene, and it’s time we had the tools to match the urgency of the situations we face. With strategic investments in infrastructure, training and policy changes, we can save more lives and reduce preventable deaths from traumatic hemorrhage.

This isn’t just about carrying blood products — it’s about delivering on our promise to save lives, no matter where or when the call comes in. Let’s make sure that when it matters most, we have the blood on hand to make a difference.

Additional whole blood resources:

Clinical EMS Protocols EMS Training and Education Medical Director Patient Assessment Whole Blood