Objectives: In Georgia, the paramedic’s scope of practice prohibits the initiation of blood products. Due to the rural landscape in Georgia, with prolonged transport times, one region’s Regional Trauma Advisory Committee (RTAC) advocated to expand the scope of practice for Georgia’s paramedics, to allow them to initiate life-saving blood products in the prehospital environment in hopes of improving outcomes in bleeding patients. The pilot project effort was to illustrate the safety of paramedics initiating blood products in the field and to determine the repeatability of the project for other services. This study evaluated the safety and feasibility of allowing paramedics in the prehospital environment to initiate blood products for hemorrhaging patients utilizing a regionally established prehospital blood pilot program.
Methods: Approval was obtained from the state medical director’s group and the Office of EMS and Trauma. The project team addressed product selection, equipment needs, prehospital service selection, educational requirements, policies and procedures, monitoring, and performance improvement. Four EMS services were identified to participate. Liquid plasma was selected due to cost and availability. Equipment was then secured for blood storage and temperature monitoring to ensure the hospital’s blood bank could maintain standards for exchange. A transfusion guideline was created, a detailed administrative policy was developed, and a thorough education plan, including didactic and hands-on testing, was developed. A well-coordinated exchange process with the trauma center’s blood bank was also instituted to minimize waste and reduce costs
Results: The pilot project began in the spring of 2020 and as of the end of August 2022, there have been 84 field initiations and no adverse effects, demonstrating the safety of paramedics to initiate blood products in the field.
Conclusion: A post licensure skill for paramedics is now available in Georgia for the initiation of blood products. The repeatability of a similar project depends on the resources available, the stakeholder commitment, and the partnerships across disciplines.
