Summer, Bloody Summer

Jul 8, 2025

Dr. Peter Antevy, an emergency physician and EMS training leader who helped implement pre-hospital whole blood programs, discusses life-saving hemorrhage control and rapid transfusion in the field. He covers criteria for activating transfusions, the critical 35-minute window, pediatric inclusion, product choices like plasma vs whole blood, and logistics of launching EMS blood programs.

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INSIGHT

Whole Blood Doubles Early Survival In Massive Hemorrhage

Prehospital whole blood for non-arrest patients with massive hemorrhage yields ~90% 24-hour survival.
Palm Beach County's experience and military data show whole blood roughly doubles survival when used for appropriately selected patients.

ADVICE

Use Specific Vital Sign Triggers For Whole Blood

Use strict physiologic triggers to target whole blood to those in true hemorrhagic shock.
Palm Beach criteria: suspicion of massive hemorrhage plus either SBP <70, or SBP <90 with HR ≥110 (with beta/Ca-channel caveat), ETCO2 <25, or crew discretion.

ANECDOTE

Four-Year-Old Woke After IO Whole Blood On I-95

A four-year-old with a femur fracture received IO whole blood and woke after 10 cc/kg then again after more, ultimately survived with external fixation.
Palm Beach crew used a LifeFlow infuser; the child received 17 squeezes and left the hospital a week later.

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Get ready for a transformative episode of the FlightBridgeED Podcast, where host Eric Bauer teams up with EMS trailblazer Dr. Peter Antevy to dive into the life-saving world of pre-hospital hemorrhage control and blood product administration. Discover how whole blood is reshaping trauma care, doubling survival rates for patients bleeding out from trauma, OB emergencies, or medical crises. Dr. Antevy shares hard-won lessons from Palm Beach County, revealing the vital signs that trigger transfusions, the logistics of launching a blood program, and why resuscitating before intubating is a game-changer. From a child saved on I-95 to a police officer revived after a ricochet wound, these gripping stories bring the science to life. Plus, peek into the future with spray-dried plasma and TBI protocols that could redefine EMS. Whether you’re a seasoned critical care provider or just starting your journey, this episode will ignite your passion for saving lives.

Listen anywhere you enjoy podcasts or at flightbridgeed.com, where you can also explore our award-winning courses to fuel your growth in critical care medicine.

AS PROMISED, HERE IS DR. ANTEVY'S EMAIL ADDRESS IF YOU WANT TO REACH OUT: peter@handtevy.com

Key Takeaways

Whole blood administration in pre-hospital trauma care achieves a ~90% 24-hour survival rate for non-arrest patients with massive hemorrhage, using criteria like systolic BP <70, heart rate ≥110, or end-tidal CO2 <25, emphasizing the need for precise patient selection and rapid intervention within 35 minutes of injury.
Prioritizing resuscitation over intubation prevents peri-intubation cardiac arrest in hypotensive trauma patients, as shown by a tenfold reduction in intubation rates in New Orleans’ advanced resuscitative care bundle, highlighting the importance of restoring perfusion first.
Plasma or packed red blood cells can be effective alternatives when whole blood isn’t available, but providers must manage citrate-induced hypocalcemia (e.g., with calcium chloride) and use tools like the LifeFlow infuser for rapid transfusion.
Networking and advocacy are critical for EMS innovation: connecting with resources like San Antonio’s summits or the SPARC Academy can help overcome barriers to implementing blood programs, empowering providers to drive change in their communities.