Why isn't blood plasma used in pre-hospital in the US anymore?

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TimRaven

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This question has been in my mind for awhile, and I couldn't find answer in my textbook or online.

Why did we stop giving blood plasma to trauma patients in the pre-hospital in the US after Vietnam war?
Isn't plasma supposedly helping clotting process and fighting infection? I know it is still used by the military, and by other countries till this day, often in dehydrated powder form.
 
Plasma is simply one part of blood. In most major trauma the tendency has been to use 1:1:1 ratio of plasma (as FFP), platelets and red cells, however as I understand, this has evolved somewhat to just giving whole blood

Whole blood is being given in the prehospital phase in a number of places around the world. I do not think it will ever be a routine thing carried on every ambulance unless some sort of man-made blood can be invented.
 
SpecialK said:
Plasma is simply one part of blood. In most major trauma the tendency has been to use 1:1:1 ratio of plasma (as FFP), platelets and red cells, however as I understand, this has evolved somewhat to just giving whole blood

Whole blood is being given in the prehospital phase in a number of places around the world. I do not think it will ever be a routine thing carried on every ambulance unless some sort of man-made blood can be invented.
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The few areas that carry blood products carry ffp or prbc. I know of no prehospital agencies carrying whole blood. Although that would be the best.thing to carry
 
Im not aware of plasma ever being used in American EMS.

And if it was, I think a better question would be "why was blood plasma ever used in pre-hospital in the US"?
 
Having blood products on every ambulance would be awesome. However it would be a logistical nightmare with massive amounts of wasted blood when there's continuous shortages for hospitals themselves.


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From what I read in pre-1980 military medicine manuals, it was common practice to give reconstitute blood plasma to trauma patients to improve their clotting factors, a few civilians services also have similar practice.

The practice is still used today in the military:
http://www.militaryblood.dod.mil/viewcontent.aspx?con_id_pk=1665

here are a few pictures of equipment:
Britain_and_us_plasma_packages_wwii.jpg

ch07fig39.jpg

Private_Roy_W._Humphrey_of_Toledo%2C_Ohio_is_being_given_blood_plasma_after_he_was_wounded_by_shrapnel_in_Sicily_on_8-9-43_-_NARA_-_197268.jpg


My question would be:
Why was this practice rarely used in civilians field? Was there some severe complication with it?
Wouldn't it provide a way to improve clotting thus survival rate like TXA does?
 
TransportJockey said:
I know of no prehospital agencies carrying whole blood. Although that would be the best.thing to carry
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NSW Ambulance (GSA-HEMS)
Air Ambulance Victoria (part of AV)
ARHT/Westpac Rescue (Auckland HEMS)
London HEMS
Medcall GmbH

All of these services respond by road as well as air. The QAS are carrying PRBCs.

I do not think it whole blood will become standard on every ambulance but as it becomes more practical to carry it will become more common for HEMS or the hyper-acute critical care paramedic environment. Of course, that is until science invents a whole blood substitute.
 
SpecialK said:
NSW Ambulance (GSA-HEMS)
Air Ambulance Victoria (part of AV)
ARHT/Westpac Rescue (Auckland HEMS)
London HEMS
Medcall GmbH

All of these services respond by road as well as air. The QAS are carrying PRBCs.

I do not think it whole blood will become standard on every ambulance but as it becomes more practical to carry it will become more common for HEMS or the hyper-acute critical care paramedic environment. Of course, that is until science invents a whole blood substitute.
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Fair enough. I completely spaced that in other countries they might be carrying whole blood. Here in the US, components are common whereas whole blood is not
 
My understanding is that the demand for blood is way down because hospitals now have a way to keep the same packet viable for longer. However, this is admittedly imprecise information so if someone can explain that it'd be great.
 
Ensihoitaja said:
We're part of a study on carrying and administering fresh frozen plasma on the ambulance. We're 2 years in and there's another year to go. I know the trauma surgeons are really excited about it, but I don't have any idea what preliminary results have been like.

COMBAT Study- http://www.denverhealth.org/for-pro...-center/research-and-publications/combattrial
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Ya'll are always doing all sorts of cool **** up there. I can't wait to read what thr esults from the study show.
 
Taming the SRU mentioned a while back that their HEMS service was trying fresh (non-frozen) plasma due to shelf life advantages.
http://www.tamingthesru.com/blog/prehospital-medicine/liquid-plasma-aka-never-frozen-plasma
I don't know if they're still doing it or have published anything.
Another interesting point from (I think) that podcast: the US started fractionating blood products for oncology patients, not because of benefits in storage or efficacy in trauma.
 
One interesting comparison for the COMBAT study versus the fresh plasma mentioned in the podcast... our FFP is 500 mL frozen in a 2 L bag, so it's flat with a lot of surface area. We can thaw one unit in a plasmatherm in 3 minutes, 20 seconds and a second in another 3:20.
 
Another interesting thing that could eventually make its way over here is FLyP. Stands for French Lyophilized Plasma, and is basically freeze dried plasma. Stored in a bottle, and has a shelf life at room temperature for years. You reconstitute it with sterile water I believe, and its ready for infusion in about 5 minutes. It is currently in small scale tests with French and US special operations forces. Obviously, right now, it is very expensive.
 
MonkeyArrow said:
Another interesting thing that could eventually make its way over here is FLyP. Stands for French Lyophilized Plasma, and is basically freeze dried plasma. Stored in a bottle, and has a shelf life at room temperature for years. You reconstitute it with sterile water I believe, and its ready for infusion in about 5 minutes. It is currently in small scale tests with French and US special operations forces. Obviously, right now, it is very expensive.
Click to expand...

According to the trauma service, freeze-dried plasma is where there hoping to go next if the COMBAT/FFP study has positive results.
 
TransportJockey said:
Fair enough. I completely spaced that in other countries they might be carrying whole blood. Here in the US, components are common whereas whole blood is not
Click to expand...

I believe the local HEMS carry 2 units of PRBC and 2 units of FFP on their helicopters.
 
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