Blood product administration in the prehospital setting: a multisociety consensus statement

Abstract

The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has led the development of a Good Clinical Practice (GCP) document, engaging multiple scientific societies-including the Italian Society of Transfusion Medicine and Immunohematology (SIMTI), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Emergency Medicine (SIMEU), the National Association of Critical Care Nurses (ANIARTI), and the Italian National Blood Centre (Centro Nazionale Sangue-CNS). This collaborative effort aims to establish a multidisciplinary consensus on the administration of blood products in the prehospital management of patients with life-threatening hemorrhage. The increasing adoption of prehospital transfusion programs worldwide, particularly in trauma care, highlighted the need for structured recommendations that ensure safety, effectiveness, and compliance with current regulations. In prehospital settings, the early administration of packed red blood cells, fibrinogen concentrate, and fresh frozen plasma is not only considered feasible but has also shown to be potentially effective in improving hemodynamic stability and reducing mortality in patients with hemorrhagic shock. However, these benefits are strongly influenced by factors such as patient selection, timing of intervention, and the integration of transfusion protocols into advanced prehospital care systems. Implementing strict clinical governance, ensuring appropriate storage conditions, and developing standardized documentation processes are key to the success of these programs. Furthermore, close collaboration between emergency medical services and blood banks is essential to ensure compliance with national guidelines and to optimize patient outcomes. This consensus document was developed through a systematic literature review and a modified Delphi method, involving blind voting and consensus evaluation using a Likert scale. The process was conducted over two rounds of online voting. The document addresses four critical topics: the selection of blood product derivatives for prehospital use, safety requirements for their transport, documentation and traceability standards, and procedures for the return of unused components.

Keywords: Blood products; Clinical governance; Emergency medical services; Fibrinogen concentrate; Hemorrhagic shock; Prehospital transfusion; SIAARTI; Trauma care.