Abstract
Background The success of prehospital blood transfusion programs depends not only on clinical guidelines and provider competencies but also on robust program coordination.
Methods This guidance defines the scope and responsibilities of Emergency Medical Services (EMS) Blood Program Coordinators and Program Managers, in alignment with the AABB (American Association of Blood and Biotherapies) Standards for Emergency Prehospital and Scheduled Out-of-Hospital Transfusions, as well as the Prehospital Blood Transfusion Coalition (PHBTC) clinical practice guideline for civilian EMS. Coordinators oversee program implementation, regulatory compliance, operational logistics, and quality management under the supervision of the Transfusion Administration Service medical director.
Results Responsibilities include validating storage and transport systems, ensuring continuous monitoring of blood components, standardizing education, and facilitating interagency collaboration. By formalizing this role, the guideline supports safe and consistent program operations across diverse EMS systems.
Conclusion Collectively, the PHBTC series provides a structured framework to advance prehospital transfusion as a reliable, evidence-based intervention that improves outcomes for patients with life-threatening hemorrhage.
Purpose
This clinical practice guideline (CPG) provides essential guidance for Emergency Medical Services (EMS) Blood Program Coordinators (‘Coordinators’) for prehospital EMS systems. This guideline supports the implementation, maintenance, and continuous improvement of prehospital blood transfusion programs through comprehensive education for coordinators, standardized processes, and quality management. This role requires a thorough understanding of clinical evidence, regulatory requirements, operational logistics, and coordination with multiple stakeholders across the healthcare continuum.
The coordinator serves as the EMS agency’s designee responsible for ensuring compliance with the American Association of Blood and Biotherapies (AABB) Standards for Emergency Prehospital and Scheduled Out-of-Hospital Transfusions (POHT) and all applicable federal, state, and local regulations. This role is critical for maintaining the quality system (AABB POHT Standard 1.2) under the supervision of the Transfusion Administration Service (TAS) medical director (AABB POHT Standard 1.1.1). The TAS is responsible for ensuring that containers used for handling, storing, and transporting blood and blood components are validated to maintain acceptable temperatures for the expected duration (AABB POHT Standard section 3). The TAS is also responsible for continuously monitoring and recording the temperature of blood and blood components during storage and transport. Prehospital transfusion programs are highly encouraged to have access to these standards for reference. This document is intended to accompany other prehospital transfusion coalition resources for the program, including the Prehospital Blood Transfusion Coalition (PHBTC)-CPG for civilian EMS.1
Introduction
Prehospital blood transfusion programs involve a complex integration of clinical care, regulatory compliance, logistics, and system-wide coordination. These programs require alignment among EMS agencies, trauma systems, blood suppliers, and regulatory bodies to ensure the safe and timely delivery of blood products. Historically, each 10-minute delay in transfusion was associated with a 27% increase in odds of death, highlighting the critical importance of effective operations.2 More contemporary data have shown that every 1-minute delay in prehospital resuscitation was associated with a 2% increase in the odds of 24-hour and 30-day mortality in both blunt and penetrating trauma.3 As adoption grows, variability in implementation and oversight remains a significant challenge. Given this complexity, the Blood Program Coordinator plays a vital role in operationalizing clinical evidence into safe, scalable, and compliant practice.
This CPG represents a living document intended to outline the core competencies, responsibilities, and best practices for Blood Program Coordinators. It is based on current evidence from landmark trials, including Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR)4 and Prehospital Plasma During Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock (PAMPer),5 and regulatory standards from the Food and Drug Administration (FDA) and AABB, as well as operational experience from established programs. The coordinator must possess both clinical understanding and administrative expertise to ensure the safe, effective, and compliant blood product administration programs in the prehospital setting.
These guidelines should be implemented in alignment with national standards, state regulations, local medical oversight, and regional/institutional policies. Successful programs require dedicated coordinator leadership to navigate complex regulatory environments, maintain stakeholder engagement, and drive continuous quality improvement as outlined in the THOR-AABB Working Party recommendations6 and the PHBTC-CPG for civilian EMS.1
Conclusion
The Blood Program Coordinator role is essential to successful prehospital transfusion program implementation and sustainability. Through mastery of clinical knowledge, regulatory requirements, operational logistics, and quality improvement, coordinators enable life-saving interventions at the point of injury or illness to improve patient outcomes. This guideline provides a framework for excellence in program coordination, supporting the delivery of evidence-based care that saves lives across diverse communities. As stated in the AABB Standards, “The goal of the Prehospital and Out-of-Hospital Standards is to maintain and enhance the quality and safety of prehospital and out-of-hospital transfusions.” The Blood Program Coordinator serves as the guardian of this mission.
