Hemorrhage remains one of the leading causes of preventable death in trauma and critical illness. Prehospital blood transfusions are used to treat hemorrhagic shock early - improving oxygen delivery and survival for patients at risk of exsanguination.

Delays in administering a necessary blood transfusion to patients with severe traumatic hemorrhage have been shown to significantly worsen patient outcomes.  Studies of patients with hemorrhagic shock suggest that delays in initiating blood transfusion are associated with higher mortality, reinforcing the importance of early recognition and timely access to blood when clinically indicated.

Vital Match is a Red Cross initiative designed to support the responsible expansion of prehospital blood transfusion programs and help EMS agencies implement field-based transfusion capabilities.

By combining clinical education with comprehensive program support, including guidance on product selection, product training, storage, and inventory practices that minimize wastage, Vital Match helps EMS providers navigate operational complexities and deliver lifesaving care with confidence, consistency, and reliability.

Implementing a robust and thoughtfully designed prehospital blood program through Vital Match supports the Red Cross mission to advance patient survival by delivering innovative, sustainable transfusion solutions across the continuum of care.

No. While EMS providers should consult with their medical team to evaluate their EMS need for blood products, there’s a strong case for more EMS systems to carry blood. However, it may not be realistic or even appropriate for all EMS agencies to do so.

Blood products should be reserved for EMS vehicles that are likely to encounter trauma patients or those with severe bleeding. EMS systems should have the capability to deliver early blood transfusions where it will meaningfully improve patient outcomes, and the Red Cross can help you evaluate your program and determine whether blood products are suitable.

While no single blood product has emerged as definitively superior in prehospital care, blood products collectively demonstrate clear clinical benefits compared with crystalloids, underscoring the limitations of the current standard of care.

• Excessive crystalloid resuscitation has been associated with the development of coagulopathy and increased mortality in severely bleeding patients.

Recognizing the diversity of prehospital environments and the need to limit wastage, the Red Cross offers multiple blood product solutions, including:

• Red Blood Cells (Type O+)
• Low Titer O Whole Blood (Type O+)
• Liquid Plasma (Type A)

Our Medical Office provides expert guidance to support EMS providers evaluating appropriate blood product selection and recommendations for stocking.

The Red Cross does not accept EMS returns into Red Cross inventory. However, EMS agencies may choose to establish local hospital rotation or transfer agreements where feasible, subject to hospital acceptance criteria, product condition, documentation, remaining shelf life, and applicable regulatory requirements. Each transfer between a blood supplier, EMS agency, and/or hospital adds cost, introduces delays, and reduces the time a unit is available for patient use, ultimately decreasing the likelihood it will be transfused before expiration. 

This challenge is even greater in areas without local hospitals able to accept short-dated units. Returned blood is often too close to expiration to be effectively used, meaning it may not result in a viable unit for patient care. Additionally, frequent redistribution efforts can divert attention and resources from the core mission of collecting and producing blood products to meet active patient needs.

A more effective approach is to prevent waste upfront by determining the best products to carry, right-sizing EMS inventory and when feasible, supporting local hospital partnerships that are able to use short-dated units when possible. EMS providers should consult with their medical team to evaluate the appropriate blood product inventory that will meet their EMS teams’ needs.

Blood products must be stored under continuously monitored, validated temperature-controlled conditions appropriate for the product. For refrigerated blood products, this means 1–6°C. Products should remain in validated storage or transport devices until needed for transfusion, and EMS agencies should have procedures for documenting temperatures, responding to excursions, and determining whether a product remains acceptable for use.

We provide leukoreduced low titer group O positive whole blood (LTOWB), with a titer of less than 200.  These units are generally distributed within 5 days of collection (5 days fresh) and have a shelf-life of 21 days.

The overall risk of anti-D alloimmunization when using type O positive blood in emergency settings is low—generally estimated between 3% and 6%—in part because the majority of patients are already Rh-positive.

Evidence supports that administering uncrossmatched Rh-positive red blood cells or whole blood in emergencies, is a generally safe and appropriate practice when clinically indicated. 

Importantly, current evidence also indicates that exposure to a greater number of Rh-positive units does not significantly increase the likelihood of alloimmunization.

In the setting of life-threatening hemorrhage, the immediate benefit of rapid access to blood products and restoration of circulating volume and oxygen-carrying capacity far outweighs the relatively low risk of alloimmunization. Additionally, carrying Group A liquid plasma can further help mitigate the risk of anti-D alloimmunization in Rh-negative patients, including females of childbearing potential.

The Red Cross serves over 150 EMS agencies directly and several others via hospital partnerships.  EMS can contract directly with the Red Cross or can partner with a hospital blood bank to receive units.

No. While the Red Cross recommends hospital collaboration to balance supply and wastage, we recognize that isn’t always feasible. We serve EMS programs both through a direct model and via hospital collaboration.

The Red Cross is proud of its effort to provide its clients with a robust and stable blood supply, however intermittent blood shortages occur with all blood suppliers. This can be especially true during holidays, winter storms, natural disasters, or other events that may impact the ability to collect or transport blood products. Group O blood products are in highest demand and can be susceptible to temporary inventory constraints.

EMS programs can mitigate impacts from shortages by allowing product flexibility in their SOPs; for example, if your program primarily uses LTOWB, ensure that SOPs also allow use of O positive red blood cells or group A plasma to minimize disruptions and ensure patient access to life-saving blood products during a temporary shortage.

The most effective way to limit waste is through upfront planning and selecting the product that best aligns to your operation.

• Stock the minimum number of units necessary to have impact
• Place products only on vehicles most likely to encounter bleeding patients
• Employ a phased approach to grow the program responsibly

Product Selection: Select the optimal product for your EMS program. LTOWB, O positive red blood cells, and Group A liquid plasma all have different shelf lives which can materially impact wastage rates.

Right-size your inventory. Use historical data to determine transfusion rates or, if you are implementing blood products for the first time, rates of patient cases that would potentially qualify for transfusion for each ambulance.  Prioritize inventory for vehicles most likely to encounter severely bleeding patients or choose longer shelf-life or lower cost product options for vehicles that encounter bleeding patients less frequently.

Build partnerships with local hospitals.  Identify local hospitals that may serve as potential transfer partners and engage them in discussions to determine the types and quantities of blood products they can accept and are likely to transfuse before expiration. Establish clear expectations for the minimum remaining shelf life required for the hospital to confidently utilize transferred units.

• Account for Reduced Usable Shelf Life
  • While partnerships with local hospitals are encouraged where feasible, it is important to recognize that transferring units effectively shortens the usable shelf life for the EMS program. Adequate time must remain for the receiving hospital to safely transfuse the product before expiration. In some cases—particularly when inventory is well “right-sized”—maintaining units within the EMS program and utilizing them throughout their full shelf life may result in lower overall wastage.
• Continuously Monitor and Adjust
  • Routinely track wastage rates and trends over time. Use this data to inform adjustments to product type, inventory levels, and stocking practices to maintain low wastage while ensuring clinical readiness.

The Red Cross Medical Office is available to provide complimentary education and consultation on prehospital blood products. We offer EMS data-driven recommendations on appropriate product selection, inventory quantities, and rotation models—maximizing patient benefit while minimizing waste.

Yes. The Red Cross believes that supplying blood to both hospitals and emergency medical services (EMS) is not only feasible, it is essential to improving patient outcomes across the continuum of care.

As a leading blood supplier and a recognized leader in blood collection, stewardship, and emergency response, the Red Cross is uniquely positioned to meet this need. Our established infrastructure, operational expertise, and national scale enable us to efficiently manage supply and distribution across diverse care settings.

We have the capacity to grow the overall blood supply — particularly Group O, which is critical for emergency use — allowing us to support EMS programs without compromising hospital needs. Importantly, our efforts are focused on expanding supply, not reallocating existing resources.

Through proactive planning, targeted donor recruitment, and robust collection strategies, we are building a stable and resilient blood supply. These efforts ensure that both hospitals and EMS providers have reliable access to the blood products they need, when and where they need them.

EMS agencies interested in implementing prehospital blood transfusion programs should begin by engaging their medical director and internal leadership to assess clinical need and operational readiness. This includes reviewing call volume and hemorrhage-related data, identifying appropriate vehicles or teams for deployment, and evaluating storage and temperature-monitoring capabilities.

Agencies should also determine whether a direct relationship with the Red Cross or a hospital partnership model is the best fit for their system. The Red Cross can support EMS programs at every stage of development, offering education on blood products, data-driven inventory planning, and implementation guidance tailored to local operational and clinical needs.

The Red Cross delivers a comprehensive range of EMS training services through its Resuscitation Suite™, designed to support providers across the full continuum of prehospital care. This includes:

• Basic Life Support (BLS): Foundational training in high-quality CPR, AED use, team dynamics, and basic airway management for first responders and healthcare providers.
• Advanced Life Support (ALS): Advanced, scenario-based training focused on cardiac arrest management, pharmacology, airway interventions, and critical decision-making for paramedics and advanced providers.
• Pediatric Advanced Life Support (PALS): Specialized training for recognizing and managing pediatric emergencies, including respiratory distress, shock, and cardiac arrest, with an emphasis on rapid assessment and intervention.
• *NEW* Neonatal Advanced Life Support (NALS): Targeted education for newborn resuscitation, covering neonatal physiology, resuscitation techniques, and coordinated team-based care for high-risk deliveries.

These programs are built on evidence-based guidelines, emphasize hands-on practice and real-world simulations, and can be delivered flexibly to meet agency needs. Backed by decades of experience and a national network of partnerships across EMS, hospitals, and trauma systems, the Red Cross supports more than 1,000 police, fire, and EMS agencies, helping ensure teams are prepared to deliver high-quality, lifesaving care when and where it is needed most.