Prehospital Whole Blood Program

The program's medical director for special operations is Alvin Wang, DO, FAAEM, FAEMS, NRP.Every prehospital blood transfusion is reviewed by Dr. Wang and the Bensalem Rescue Squad Clinical Care Committee. This review includes:Whether the patient met the criteria for transfusionWhether the blood was stored, handled, and administered correctlyThe patient's response to treatmentDocumentation and transfer of care to the hospitalAny opportunities to improve training, equipment, policy, or patient careThis review process helps protect patient safety and supports continuous improvement of the program.

The whole blood used by Bensalem Rescue Squad is supplied and managed through the blood banks at Trinity Health Mid-Atlantic, St. Mary Medical Center, and Jefferson Health, Jefferson Torresdale Hospital.Blood comes from volunteer donors. Each unit is tested for blood type, carefully screened for infectious diseases, and inspected by the donation program and blood bank before it is released for potential utilization on a patient.The blood is stored in a highly specialized medical cooler that maintains a safe storage temperature. The temperature is continuously recorded and monitored. If the blood is not kept within the required temperature range, it cannot be used.

Only Bensalem Rescue Squad paramedics who have completed the required education, demonstrated competency, and received individual authorization from the agency medical director may administer whole blood.Credentialed paramedics follow the Pennsylvania Advanced Life Support Protocols, including the statewide protocol for prehospital blood-product administration. They also follow Bensalem Rescue Squad policies and procedures.Bensalem Rescue Squad paramedics have completed several hours of education and practical training beyond the minimum required to perform this intervention. Training includes:Recognizing hemorrhagic shockSelecting appropriate patientsObtaining informed consentConfirming the correct blood productPreparing and warming the bloodSafely administering a transfusionMonitoring the patientRecognizing and treating a transfusion reactionPediatric dosingBlood storage and temperature monitoringDocumentation and hospital handoffHands-on practice and competency testingParamedics must continue to demonstrate competency to remain authorized to give blood.

Whole blood may be used when a patient has severe bleeding and signs that the body is no longer circulating enough blood and oxygen. This condition is called hemorrhagic shock.Possible causes include:Serious motor vehicle, motorcycle, bicycle, or pedestrian crashesGunshot or stab woundsTraumatic amputationsMajor crush injuriesSevere gastrointestinal bleedingRuptured aneurysms or other major internal bleedingSevere bleeding during or after childbirthOther medical or traumatic conditions that cause major blood lossNot every patient with bleeding needs a transfusion. Paramedics assess the patient's blood pressure, mental status, breathing, pulse, skin condition, and other signs of shock before deciding whether blood administration is appropriate.

Bensalem Rescue Squad carries low-titer 0-positive whole blood, often shortened to LTOWB or LTO+WB."Low-titer" means that the blood has been tested and contains only a low level of certain antibodies that could react with another person's blood cells. This lowers the risk of a serious reaction when the patient's blood type is not yet known."Type O" blood can be given to most patients during an emergency when there is no time to determine the patient's blood type."Positive" refers to the Rh factor, a protein found on red blood cells. Because the blood carried by Bensalem Rescue Squad is Rh-positive, there is a small chance that an Rh-negative patient could develop antibodies after the transfusion. This is mainly a concern for patients who may become pregnant in the future. The receiving hospital can perform additional testing and provide treatment when needed to help prevent this reaction from happening.During life-threatening bleeding, the immediate benefit of replacing lost blood will usually outweigh this future risk.

A patient who is bleeding heavily is losing much more than fluid.The patient is losing:Red blood cells, which carry oxygenPlasma, which supports blood volume and contains clotting proteinsPlatelets, which help the blood form clotsNormal saline can temporarily add fluid to the bloodstream, but it cannot carry oxygen or replace the parts of blood needed for clotting.Whole blood replaces red blood cells, plasma, and platelets together in one product. This makes it well suited for treating severe blood loss.

Blood transfusion is a well-established medical treatment. However, no medical treatment is completely without risk.Possible transfusion complications include:FeverAllergic reactionsBreakdown of transfused red blood cellsBreathing problemsFluid overloadTransmission of an infectionDevelopment of antibodies against the Rh factorModern donor screening, laboratory testing, blood-bank procedures, and the use of low-titer blood make serious reactions uncommon.Bensalem Rescue Squad paramedics are trained to identify and treat possible complications. The program also includes strict requirements for blood storage, temperature monitoring, patient monitoring, documentation, hospital notification, and medical review.

Whole blood may be given to patients older than one year who have suspected severe blood loss and signs of hemorrhagic shock.Paramedics consider the patient's:Age and weightBlood pressureHeart rateMental statusBreathingSkin color and temperatureOverall clinical conditionA patient does not qualify simply because bleeding is present. The bleeding must be severe enough to cause, or be strongly suspected of causing, shock.Whole blood is generally not given when the patient's shock is caused by something other than blood loss. Under the current Pennsylvania EMS protocol, blood is also not administered to a patient who is already in cardiac arrest.

Yes. Bensalem Rescue Squad's program allows specially trained and credentialed paramedics to give whole blood to children older than one year when they meet the clinical requirements according to PA's Commonwealth EMS protocols.For children and smaller patients who weigh less than 50 kilograms, the amount of blood is based on body weight. Paramedics coordinate the transfusion with a medical command physician.

When the patient is awake, understands the situation, and can make medical decisions, the paramedic will explain:Why a blood transfusion is recommendedWhat type of blood will be givenThe expected benefitsThe important risksOther available optionsWhat could happen if the patient refusesA patient who has decision-making capacity may refuse a blood transfusion, even when refusing could result in death.For a child, paramedics will seek consent from a parent or legal guardian when one is present or immediately available. The child should also be included in the discussion when appropriate for the child's age and level of understanding.In some emergencies, the patient may be unconscious, confused, critically ill, or unable to communicate. If delaying treatment would create an immediate threat to the patient's life and no decision-maker is available, paramedics may provide treatment under emergency implied consent. This same concept of implied consent is used by EMS and hospitals to treat patients with serious emergencies who cannot provide informed consent.Paramedics will respect medical-alert jewelry, wallet cards, advance directives, or other reliable instructions showing that a patient does not accept blood products, as long as looking for that information does not dangerously delay care.

No. Bensalem Rescue Squad currently carries one unit of low-titer 0-positive whole blood with the on-duty Battalion Chief/ Paramedic Supervisor. Overnight, when a Battalion Chief/ Paramedic Supervisor is not staffed, the unit is instead carried by the on-duty ALS crew.This allows the blood to be deployed wherever it is needed within Bensalem Township. The Battalion Chief/Paramedic Supervisor - or, overnight, the on-duty ALS crew - may respond directly to the emergency or meet another EMS crew at the scene or during transport.This model keeps the blood available throughout the Township while reducing unnecessary duplication, protecting a limited community resource, and supporting close oversight of storage and temperature monitoring.Blood availability depends on whether the unit has already been used, whether it has remained within the required temperature range, and the current regional blood supply.

Yes, when operationally possible.Bensalem Rescue Squad is willing to support neighboring EMS agencies through established mutual-aid agreements when a patient may need emergency blood transfusion.The Battalion Chief/ Paramedic Supervisor - or, overnight, the on-duty ALS crew - can be requested to respond with the blood unit and meet the local EMS crew. Bensalem's credentialed paramedics will assess the patient and provide treatment according to Pennsylvania ALS protocols, agency policy, and medical direction.Mutual-aid deployment depends on:The location and urgency of the emergencyAvailability of the Battalion Chief/ Paramedic Supervisor (or on-duty ALS crew} and blood unitBensalem Rescue Squad's current emergency call volumeTravel timeThe patient's clinical conditionThe need to maintain appropriate emergency coverage within Bensalem TownshipThe response should never delay the patient's transport to the hospital. When appropriate, the Bensalem Rescue Squad ambulance may intercept the transporting ambulance while it is already traveling toward the hospital.

Medical literature has demonstrated that prehospital blood transfusions may make an important difference for selected patients.Severe bleeding is a time-sensitive emergency. Starting a transfusion before the patient reaches the hospital allows paramedics to begin replacing oxygen-carrying red blood cells and clotting components earlier.Several studies have linked earlier blood transfusion with improved survival and a reduced need for additional blood products in some groups of patients. However, the research does not support promising a specific survival rate for every patient.The benefit depends on many factors, including:How much blood the patient has lostThe cause of the bleedingHow quickly the bleeding is controlledHow soon the transfusion beginsThe patient's other injuries or medical conditionsTransport time to the hospitalThe need for surgery or other hospital treatmentPrehospital whole blood is not a replacement for rapid transport, bleeding control, surgery, or hospital care. Giving blood in the prehospital setting is another advanced treatment that allows patient resuscitation to begin as early as possible.

No. Receiving whole blood from Bensalem Rescue Squad does not require a patient to be transported to a specific hospital.Paramedics will transport the patient to the most appropriate hospital based on the patient's condition, the suspected cause of bleeding, Pennsylvania EMS destination protocols, hospital capabilities, and transport time.For example, a patient with a serious traumatic injury may need to be transported directly to a designated trauma center. A patient with pregnancy-related bleeding, a ruptured aneurysm, or another specialized emergency may require a hospital with the appropriate surgical or specialty services.Bensalem Rescue Squad is deeply grateful to Trinity Health, Mid-Atlantic, St. Mary Medical Center and Jefferson Health, Jefferson Torresdale Hospital and respective blood banks for making this program possible. Their partnership provides the blood product, blood-bank expertise, storage guidance, quality safeguards, and clinical support needed to safely bring whole blood into the prehospital setting.That partnership does not determine where a patient must be transported. The patient will always be taken to the facility best able to treat the underlying emergency, while the whole blood program allows life-saving resuscitation to begin before hospital arrival.

A unit of whole blood can be used for 21 days after it is collected from a donor. Unused blood is not automatically thrown away. Bensalem Rescue Squad returns each unit to the respective hospital blood banks before it reaches the end of its approved storage period.Because the blood may still be used on another patient, the unit is returned early enough for the hospital to place it back into its available blood supply and use it before it expires. This helps protect a limited community resource and reduces unnecessary waste.

Bensalem Rescue Squad follows strict storage and temperature-monitoring procedures whenever a unit is in our care and in compliance with PA EMS protocols, PA Bureau of EMS regulations, and AABB best practices.The blood is kept in a validated medical cooler with continuous electronic temperature recording and remote monitoring. Paramedics and agency leaders regularly check the cooler, the temperature data, and the condition of the blood unit. The real-time temperature history for the unit is remotely monitored by the blood bank and an electronic copy of the log is provided to the respective hospital blood bank when the unit is returned.This detailed record allows the blood bank to confirm that the unit remained within the required temperature range. When all storage requirements have been met, the blood may be safely returned to the hospital's supply and given to another patient.

Every unit of whole blood is a valuable and perishable medical resource. It comes from a volunteer donor and cannot be manufactured in a lab or easily replaced. Bensalem Rescue Squad returns unused blood early rather than holding it until its final expiration date. This gives the respective hospital blood banks enough time to use the unit for a hospital patient who needs a transfusion. Our careful temperature monitoring and early return process are important parts of the program's commitment to patient safety, responsible stewardship, and reducing blood waste. We are grateful to Trinity Health Mid-Atlantic, St. Mary Medical Center, and Jefferson Health, Jefferson Torresdale Hospital, and blood bank teams for working closely with us to make this shared-use process possible.

Transfusion reactions are uncommon, but paramedics are trained to recognize and treat them.Possible warning signs include:Fever or chillsHives or itchingWheezingTrouble breathingA sudden drop in blood pressureNew back, chest, or abdominal painA sudden change in the patient's conditionIf a reaction is suspected, the paramedic will stop the transfusion, provide emergency treatment, and notify the receiving hospital.The blood bag, tubing, and required records will be sent to the hospital so the blood bank can investigate the reaction. The case will also be reviewed by Dr. Wang and the Bensalem Rescue Squad Clinical Care Committee.

The most direct way to help is to donate blood. Every unit carried by an ambulance begins with a volunteer donor. Blood cannot be manufactured, and the regional supply must support patients in ambulances, emergency departments, operating rooms, maternity units, cancer-treatment programs, and other areas of the healthcare system.Residents can also help by learning how to control severe bleeding before EMS arrives. A person with uncontrolled bleeding can become critically ill within minutes. Immediate actions by a family member, coworker, or bystander may help keep the patient alive until paramedics reach the scene.The American College of Surgeons' Stop the Bleed program teaches residents how to:Recognize life-threatening bleedingApply firm, direct pressurePack a deep woundCorrectly apply a tourniquetContinue care until professional help arrivesA free, self-paced Stop the Bleed course is available online here: stopthebleed.org/get-trained/online-course. The online program includes videos, activities, and quizzes covering the main methods of bleeding control. Residents are also encouraged to complete an in-person skills session, which provides hands-on practice with wound packing and tourniquet use. T he hands-on portion is required to receive the full course completion certificate.

Residents can further support Bensalem Rescue Squad by:Participating in local blood drives. You can donate blood every 56 days.Taking a Stop the Bleed ™ course and encouraging family members, coworkers, schools, and community groups to do the sameKeeping an approved bleeding-control kit in an accessible locationLearning where bleeding-control kits and automated external defibrillators are located at work, school, or community facilitiesFollowing Bensalem Rescue Squad's social media pages for training opportunities, program updates, and community eventsSupporting Township funding for EMS personnel, education, vehicles, medical equipment, and advanced patient-care programsAttending public meetings and community events to learn more about local emergency servicesMaking donations through official Township-approved donation or fundraising programs for Bensalem Rescue SquadRecognizing and supporting the paramedics, EMTs, firefighters, dispatchers, and other public-safety professionals who serve the communityA successful prehospital blood program requires more than a unit of blood. It depends on volunteer donors, prepared community members, highly trained paramedics, EMS physician medical oversight, reliable equipment, hospital partnerships, quality review, and continued public support.Donate blood. Learn to stop severe bleeding. Support your local EMS system. Each action can help save a life.For questions about this program, please don't hesitate to contact the on-duty Bensalem Rescue Squad Battalion Chief / Paramedic Supervisor. Additionally, Dr. Wang can be reached at awang@bensalemrescue.org or alvin.wang@jefferson.edu.