Blood transfusion in the field is a new and growing requirement for emergency medical services. As more EMS systems bring blood products into the prehospital setting, teaching these critical procedures effectively has become essential. High-fidelity simulation stands out as the perfect training ground, to allow providers the opportunity to master these life-saving techniques without putting patients at risk. This HealthySimulation.com article by Dr. Dan Irizarry will discuss how and why to teach prehospital blood transfusion through high-fidelity clinical simulation.
Building the Knowledge Base
Before providers ever touch a simulation mannequin, they need rock-solid theoretical knowledge. A classroom session should cover the essentials: how blood products work and how to store them, when to use them in the field, how to pick the right patients, what paperwork needs to be done, and what to do when things go wrong. This foundation is critical for setting the mental framework upon which hands-on training is built.
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Walking Before Running
Good training follows a natural progression. Initial simulations should focus on basic scenarios to introduce the fundamentals for how to: handle blood products correctly, set up equipment, establish IV access, administration techniques, completion of paperwork, and communication with medical control. The use of part-task trainers in this stage focuses learning to allow for expanded complexity later. These early sessions should move at a deliberate pace to give providers time to think through each step and explain their decisions.
As confidence grows, the training evolves. Intermediate scenarios should consider common complications: equipment that stops working, blood that’s been stored at the wrong temperature, challenges with patient identification, or trouble communicating with hospitals. The most advanced sessions should tackle complex situations like how to manage multiple patients who need blood, work in terrible weather, handle transfusion reactions, or deal with mass casualties when resources run thin.
The Art of Creating Reality
Effective simulation training feels real. The simulation space should capture the challenges providers face in the field. This means running scenarios in an actual ambulance or realistic mock-up, complete with the usual chaos of sirens, radio chatter, and less-than-perfect lighting. The space needs all the tools of the trade: high-tech mannequins that display vital signs, real blood administration equipment, simulated blood products in proper storage, and standard monitoring gear. When providers step into this environment, they should feel like stepping into their everyday work world.
Learning Through Reflection: The Art of Debriefing
When the simulation ends, the real education begins. In those first crucial moments of debriefing, healthcare providers need space to decompress and share their gut reactions. Only then can the team dive into the nitty-gritty: breaking down clinical decisions, analyzing team dynamics, and evaluating how well they stuck to protocols. Video playback often reveals surprising moments – things that went unnoticed in the rush of the scenario but become crystal clear in retrospect.
During debriefing, educators should strive for double-loop learning. Unlike simple feedback that fixes immediate problems (single-loop learning), double-loop learning pushes providers to question their underlying assumptions and mental models. They don’t just ask “Did we follow the protocol?” but rather “Why do we approach these situations the way we do?” This deeper level of reflection often leads to breakthrough insights, challenging long-held beliefs and transforming how teams approach similar scenarios in the future.
The session should end with concrete action items – specific, achievable goals that bridge the gap between today’s performance and tomorrow’s actions. Quality training is not just about what went wrong or right; it’s about creating lasting change in how healthcare teams think and act under pressure to create better patient outcomes.
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How to Measure Success
Training is not complete without checking that providers can do what they have been taught. Assessment needs to look at everything from following protocols and demonstrating technical skills to thinking critically and communicating effectively. Objective measurements of performance are key to documenting proficiency. Automating data capture with supporting technologies that capture and measure task completion and align with physiologic response are ideal. These technologies reduce an educator’s cognitive strain allowing for better insight when guiding simulations.
Keep Skills Sharp and Consider How to Make The Education Work
Initial training is just the beginning. Regular refresher sessions help providers stay current with protocol updates, learn from real cases, and maintain their skills. These sessions should tie directly into quality improvement efforts, using actual case outcomes to identify what’s working and what needs attention.
When teaching blood administration through simulation, some common pitfalls need attention. First, resist the urge to teach everything at once – build complexity gradually. Second, make feedback specific and actionable rather than vague. Third, remember that the goal is competent, safe care, not perfection.
Recommended Medical Simulation Equipment
The TacMed Solutions Clinical Response Whole Body System (WBS CRU-R) represents the gold standard in medical simulation technology for blood administration training. This advanced system features anatomically accurate design with realistic, objective skill measurement, and is the industry’s most durable high-fidelity manikin making the trauma simulator particularly suitable for high-fidelity blood transfusion scenarios in the field in realistic conditions. Its ability to be divided at the waist allows an educator to use the mannequin upper and lower individually as partial task trainers. Then as scenarios progress, the two parts can be joined from complex simulation. The system’s capabilities include:
- Real-time telemetry feedback through long-range RC controller
- Advanced animatronic movements
- Realistic breathing and bleeding simulation
- Tetherless operation for enhanced mobility
- Durability for various training environments
- Comprehensive vital sign display capabilities
- Integrated sensor system for monitoring interventions
These features create an ideal platform for both basic and advanced blood administration training scenarios, whether conducted in simulated ambulance environments or field exercise conditions.
The Road Forward Takes Careful Attention
High-fidelity simulation gives providers an unmatched opportunity to master prehospital blood administration. Success comes from attention to detail in the creation of realistic scenarios, that follow a logical progression in training, and conduct thorough debriefings. Regular practice and assessment ensure providers maintain the skills they need.
Trauma Simulation is not a magic solution – clinical simulation is one part of a larger training approach that includes classroom learning, hands-on practice, and ongoing quality improvement. When done right, clinical simulation creates providers who can confidently and safely deliver blood products in the challenging world of prehospital care. This comprehensive approach ensures that when lives hang in the balance, EMS providers are ready to deliver this crucial intervention effectively.
More About Tactical Medical Solutions
TacMed Solutions creates emergency response technology, healthcare simulation tools, and protective gear to help manage injuries in hostile environments. The TacMed Solutions team of former tactical medical professionals is dedicated to protecting communities worldwide. They draw on our field experience to provide intuitive solutions for warfighters, first responders, and citizens. TacMed Solutions commitment to this mission is reflected in the durable products and excellent customer support.
The products are designed to prevent unnecessary deaths in combat situations. TacMed Solutions believes that minimizing preventable death is a realistic goal. All TacMed Solutions employees are former tactical medical professionals or have close ties to them. TacMed Solutions works with elite medics worldwide to ensure the products meet the highest standards. TacMed Solutions designs the simulator products to complement human performance under combat stress, not complicate the training experience. This approach ensures our products are effective in real-world combat scenarios.
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References:
- Bolton‐Maggs, P. H. B., & Wood, E. M. (2015). Wrong blood in tube–potential for serious outcomes: Can it be prevented? British Journal of Haematology, 168(6), 751-754.
- Callum, J. L., Lin, Y., Lima, A., & Merkley, L. (2011). Transitioning from ‘blood’ safety to ‘transfusion’ safety: Addressing the single biggest risk of transfusion. ISBT Science Series, 6(2), 404-408.
- Krook, C., O’Dochartaigh, D., Martin, D., Piggott, Z., Deedo, R., & Painter, S. (2019). Blood on board: The development of a prehospital blood transfusion program in a Canadian helicopter emergency medical service. Canadian Journal of Emergency Medicine, 21(3), 365-373.
- Marsden, M. E. R., Kellett, S., Bagga, R., Lendrum, R. A., & Naumann, D. N. (2023). Understanding pre-hospital blood transfusion decision-making for injured patients: An interview study. Emergency Medicine Journal, 40(11), 777-783.
- Powell-Dunford, N., Quesada, J. F., Malsby, R. F., Chou, V., Gerhardt, R. T., Gross, K. R., & Shackelford, S. A. (2014). Risk management analysis of air ambulance blood product administration in combat operations. Aviation, Space, and Environmental Medicine, 85(11), 1130-1135.
- Shand, S., Curtis, K., Dinh, M., & Burns, B. (2019). What is the impact of prehospital blood product administration for patients with catastrophic haemorrhage: An integrative review. Injury, 50(5), 1017-1025.
- Thies, K. C., Truhlář, A., Keene, D., Hinkelbein, J., Spahn, D. R., & Sabbe, M. (2020). Pre-hospital blood transfusion–an ESA survey of European practice. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28, 1-8.
- Turnbull, C., Clegg, L., Santhakumar, A., & Curtis, K. (2024). Blood Product Administration in the Prehospital Setting: A Scoping Review. Prehospital Emergency Care, 1-13. https://doi.org/10.1080/10903127.2024.2386007
