Paramedics in New Jersey can now administer blood transfusions at the scene of emergencies and while transporting patients to hospitals, a critical advancement that medical experts believe will save lives across the state.
That follows the Department of Health’s issuance of two waivers in late 2024 authorizing hospital systems to partner with blood banks and implement a pre-hospital whole blood and blood component administration program.
In New Jersey and across the nation, motor vehicle crashes remain a leading cause of death. Last year, nearly 700 people died in vehicle accidents in New Jersey. According to the National Highway Traffic Safety Administration (NHTSA) data, more than forty percent of crash victims nationally are alive when first responders reach the scene but later die. To achieve Vision Zero, the state is working to improve post-crash care alongside safer roads, safer speeds, safer vehicles and safer people.
Research has shown that excessive blood loss (exsanguination) remains the leading cause of preventable deaths among trauma victims, with nearly half of those patients dying within minutes of injury. According to NHTSA’s Office of EMS, pre-hospital blood product resuscitation has demonstrated a significant reduction in mortality among severely injured patients.
“These waivers represent a significant advancement in emergency care for New Jersey residents,” said Acting Health Commissioner Jeffrey Brown. “By bringing life-saving blood transfusions directly to trauma patients in the field, we’re implementing a practice that has been proven to save lives during the critical first minutes after sustaining injuries.”
In 2024, New Jersey’s mobile intensive care paramedic programs responded to 15,019 calls involving serious traumatic injuries and accidents across all 21 counties. These highly trained professionals delivered critical, life-saving interventions during the most crucial moments, demonstrating the state’s continued commitment to advancing EMS care, including the administration of blood products in the pre-hospital setting to improve outcomes for severely injured patients.
In April, Hackensack University Medical Center became the first Advanced Life Support provider in New Jersey authorized to administer whole blood transfusions in the field, and paramedics with Hackensack Meridian Health’s Emergency Medical Services have been able to administer blood directly at the scene of an emergency and during transport to the hospital.
“After working with the Department of Health to expand pre-hospital blood administration from our very successful air medical program to our ground advanced life support units, it was very rewarding for our paramedics to transfuse that first unit of blood,” said Michelle Kobayashi, MBA, MSN, RN, director of Hackensack Meridian Health‘s Transfer Center, HUMC, EMS and Emergency Community Operations. “Rather than deteriorating during the drive to the trauma center, the patient’s condition improved. This is the lifesaving care that our patients deserve.”
Two other health systems — Virtua Health and University Hospital — have also obtained authorization for pre-hospital blood transfusions. HUMC, Atlantic Health and University Hospital have been approved to transfuse blood during air medical flights, as well.
Two waivers, issued late last year, enable this best practice in pre-hospital emergency medical care. The first allows a team of two New Jersey licensed paramedics to perform blood transfusions in out-of-hospital emergencies when a physician or registered nurse is unavailable. The second waiver grants New Jersey-licensed air medical services and mobile intensive care programs the authority to implement pre-hospital whole blood and blood component administration programs.
Under the new waivers, participating services must establish written protocols for blood administration in collaboration with blood banks, complete comprehensive education programs, implement stewardship programs to prevent waste and collect extensive data on patient outcomes.
The new flexibilities align with recommendations from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians and the National Association of EMS Physicians. The organizations’ 2023 pre-hospital hemorrhage control guidance recommends EMS blood transfusions, citing research showing that transfusing severely injured trauma patients in the field is associated with a 37% reduction in mortality.
This development also builds on New Jersey’s history of innovation in emergency medical care. In June 2019, the state led the nation by authorizing paramedics to use buprenorphine to treat acute withdrawal symptoms after patients were revived from opioid overdoses with Naloxone. In February, NJDOH expanded paramedics’ authority to treat individuals with opioid use disorder by broadening the scope of buprenorphine administration in the field.
