The World’s Okayest Medic Podcast Cold Blood and Hot Traumas
Nov 9, 2026
Dr. David Rayburn, New Orleans EMS medical director, and Dr. Michael Kling, an emergency physician and former firefighter, explore prehospital blood administration. They discuss unwarmed transfusions, packed cells versus plasma, shock thresholds, calcium, and when blood may prevent unnecessary intubation. They also examine building sustainable EMS blood programs and expanding resuscitation beyond trauma.
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Do Not Withhold Blood Without A Warmer
- Do not let the absence of a warmer prevent a blood program from starting when blood is otherwise available.
- Consider climate and patient context; Minneapolis winter penetrating trauma may justify warming sooner than subtropical New Orleans.
Avoid Delaying Blood For A Warmer
- Prioritize rapid blood delivery over warming the first units when a warmer creates meaningful delay.
- The commonly cited cold-blood danger involved three to six liters, not the initial prehospital units discussed here.
Component Therapy May Stretch Blood Supplies
- New Orleans shifted from whole blood to PRBC–plasma–PRBC with TXA and calcium as component therapy became more practical.
- The service is testing whether plasma plus PRBCs can stabilize patients while conserving scarce, expensive red-cell units.