Transporting Patients with Blood/Blood Products

Bureau of EMS Policy Statement
Policy Statement # 15-06
Date September 25, 2015
Subject Transporting Patients with Blood/Blood Products
Supercedes/Updates New

The Department of Health's Bureau of Emergency Medical Services and Trauma Systems and the Blood and Tissue Resources Program have collaborated on a process to allow advanced life support ambulance services that have been approved as Ambulance Transfusion Services (ATS), to provide inter-facility transports for patients who are receiving blood or blood products.

In order for an ambulance service to transport a patient receiving blood/blood products from one hospital to another, the ambulance service must be approved by the Department as an Ambulance Transfusion Service (ATS). An ATS is defined in Section 58-2.1(ae) as:

…an ambulance service certified by the department that administers blood components during transport from one hospital to another hospital.

A new Section 58-2.16(h) adds provisions to permit Emergency Medical Technician (EMT) - Critical Care and EMT-Paramedics (EMT-CC/EMT-P) with specialized training to monitor transfusions and initiate additional units during inter-facility transport to facilitate expeditious transport of patients requiring transfusion during transport.

Notification Process:

In order for an ambulance service to be an ATS for the administration of blood/blood products to a patient being transported between hospitals, the ambulance agency must have the following in place and receive written acknowledgement from the Department:

  • The ambulance service medical director must approve the personnel training and quality assurance programs for the EMS service, as well as all personnel who will be involved in administering of blood/blood products.
  • The ambulance service should make written notification to the REMAC.
  • Only those individuals certified at the EMT-CC/EMT-P level may administer blood/blood products and monitor the medical status of those patients.
  • Each EMT-CC/EMT-P must complete the training requirements required by the Department. The training must be conducted by the agency medical director, a NYS EMT-P Certified Instructor Coordinator in conjunction with the blood bank physician with whom the agency has an agreement. Additionally, each EMT-CC/EMT-P will be required to receive updated training on an annual basis.
  • In order to obtain permission from the Department to be an ATS, the ambulance service must submit a complete Notice of Intent to Provide Ambulance Transfusion Services (ATS) to the Bureau of EMS The Notice must be accompanied by the following documentation:
    • A letter from the medical director accepting full responsibility for training staff, as well as oversight and quality assurance for the administration of blood/blood products.
    • A copy of the ambulance service's policies, procedures, and protocol for the transport of patients receiving blood/blood products.
    • A list of all advanced EMS providers approved and trained to administer/monitor patients receiving blood/blood products. The list must include EMT-CC/P certification numbers and current expiration dates.
    • A written agreement with a hospital blood bank must specify roles and responsibilities for assuring compliance with all applicable DOH regulations. The written agreement must include, but not be limited to the following:
      • Description and information on storage and transportation devices;
      • emergency protocols and procedures for adverse reactions;
      • process for providing the blood bank with appropriate patient records; and
      • participation in quality improvement programs.

    The written agreement must be approved and signed by the hospital's transfusion service director, ambulance agency medical director and chief executive officer.

  • The ambulance service must be able to do the following:
    • Transport blood/blood products in a cooler provided and tested by the hospital transfusion center.
    • Purchase and utilize an appropriate electronic patient thermometer.
    • Monitor and document the condition of the patient receiving a transfusion, which will include, but not be limited to, physical assessments, and vital signs, including temperature.
    • Recognize and treat adverse transfusion reactions in accordance with regional protocols and/or medical control.
  • The ambulance service must submit to the Department, policies and procedures for the administration and monitoring of blood/blood products with each Notice of Intent. The policies and procedures must include, but not be limited to, the following:
    • A detailed description of the process for the procurement of blood and maintaining the temperature and integrity as required by the hospital transfusion center.
    • A program of 100% quality assurance case review by the service medical director for all patients transported with blood/blood products having been administered.
    • The training program used to in-service all EMT-CC/P staff.
  • In the event of an adverse reaction, the ambulance service medical director is required to submit a report to the Department within 24 hours. The report shall include, but not be limited to, the following items:
    • A copy of the patient record.
    • A summary of the patient's presenting problems.
    • A narrative summary highlighting the Quality Assurance reviews conducted for each blood/blood product administration.
    • A copy of the medical director's review and comments.
    • The report should be sent to the following address:

      Bureau of Emergency Medical Services and Trauma Systems
      NYS Department of Health
      875 Central Avenue
      Albany, NY 12206

  • Mail the completed packet, with the signed agreement, standard operating procedures, and other relevant documents to:

    Bureau of Emergency Medical Services and Trauma Systems
    NYS Department of Health
    875 Central Avenue
    Albany, NY 12206

  • After the Department's review of the ambulance service's Notice of Intent, policies and procedures, training program and implementation plans, the Department will issue a written approval to operate as an ATS. The ambulance service may not transport a patient receiving blood/blood products until it has received the written notification.
  • Every ambulance service approved to operate as an ATS will be required to submit a renewal Notice to the Department along with the agency's biennial certification renewal application.
  • The Department will closely monitor all ambulance agencies that transport patients with blood/blood products being infused to insure that there is strict compliance with all of the applicable sections of Public Health Law, the Codes, Rules and Regulations. The Department, in accordance with 10 NYCRR Part 800, Subpart 58-2, and Article 30 of the NYS Public Health Law, may conduct a site inspection, including required documents, without prior notice of an applicant or approved Ambulance Transfusion Service. Failure to comply with any of the applicable regulations and policies may result in the revocation of the ambulance service's ATS designation.