title: Prehospital use of plasma: the blood bankers' perspective.
abstract: At the 2013 Traumatic Hemostasis and Oxygenation Research Network's Remote Damage Control Resuscitation symposium, a panel of senior blood bankers with both civilian and military background was invited to discuss their willingness and ability to supply prehospital plasma for resuscitation of massively bleeding casualties and to comment on the optimal preparations for such situations. Available evidence indicates that prehospital use of plasma may improve remote damage control resuscitation, although level I evidence is lacking. This practice is well established in several military services and is also being introduced in civilian settings. There are few, if any, clinical contraindications to the prehospital use of plasma, except for blood group incompatibility and the danger of transfusion-induced acute lung injury, which can be circumvented in various ways. However, the choice of plasma source, plasma preparation, and logistics including stock management require consideration. Staff training should include hemovigilance and traceability as well as recognition and management of eventual adverse effects. Prehospital use of plasma should occur within the framework of clinical algorithms and prospective clinical studies. Clinicians have an ethical responsibility to both patients and donors; therefore, the introduction of new clinical capabilities of transfusion must be safe, efficacious, and sustainable. The panel agreed that although these problems need further attention and scientific studies, now is the time for both military and civilian transfusion systems to prepare for prehospital use of plasma in massively bleeding casualties.
authors.affiliation: *Blood Bank, Haukeland University Hospital, and Institute of Clinical Science, University of Bergen, Norway; †NHS Blood and Transplant, Birmingham, United Kingdom; ‡Division of Transfusion Medicine, Pathology and Oncology, Johns Hopkins, Baltimore, Maryland; §Military Blood Bank, Central Military Hospital, Ministry of Defense, the Netherlands; ∥Department of Transfusion Medicine, Örebro University Hospital, Örebro, Sweden; ¶The Trauma and Combat Medicine Branch Medical Corps, Surgeon General's Headquarters, Israel Defence Force, Ramat Gan, Israel; and **Norwegian Defence Medical Service, Department of Medicine, and Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Tor
authors.initials: T
authors.lastname: Hervig
authors.forename: Heidi
authors.initials: H
authors.lastname: Doughty
authors.forename: Paul
authors.initials: P
authors.lastname: Ness
authors.forename: John F
authors.initials: JF
authors.lastname: Badloe
authors.forename: Olle
authors.initials: O
authors.lastname: Berseus
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.forename: Hans E
authors.initials: HE
authors.lastname: Heier
mesh_terms: D001771:Blood Banks; D016913:Blood Component Transfusion / Q000379:methods*; D001793:Blood Preservation; D001803:Blood Transfusion / Q000379:methods; D004632:Emergency Medical Services / Q000458:organization & administration; D004635:Emergency Medicine / Q000379:methods; D006470:Hemorrhage / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D010949:Plasma; D012151:Resuscitation / Q000379:methods*