Tactical transfusion—Importance and logistics of integrating prehospital blood in tactical EMS operations

BACKGROUND: Tactical Emergency Medical Services (TEMS) encompasses the skillset of prehospital care that is required to support all phases of operations performed by tactical law-enforcement personnel. High-risk operations can result in critical injuries to those involved. OBJECT OF THE REVIEW: Although TEMS clinicians have been taught to address critical hemorrhage, airway, and breathing issues, there is a benefit in incorporating the use of prehospital blood to reverse hemorrhagic shock. Given the unique environment in which TEMS clinicians operate, this does require forethought, planning, and modification of civilian prehospital blood protocols. DISCUSSION: This narrative review discusses the unique considerations for this area of prehospital care and reviews current examples of successful blood incorporation from four separate law-enforcement agencies, identifying variations that agencies can adopt to successfully incorporate prehospital blood into TEMS operations. CONCLUSION: We demonstrate that civilian prehospital blood protocols can be modified to allow incorporation into TEMS operations. Future research should review outcomes when blood is administered within the TEMS environment.