New SEMSTAR Framework Standardizes Data for Prehospital Transfusion Programs

A multidisciplinary expert panel has published a new consensus-based framework to standardize data elements and outcome definitions to facilitate consistent reporting among prehospital blood transfusion programs.

Prehospital transfusion programs have expanded in recent years as early blood product administration has been associated with improved outcomes in patients experiencing hemorrhagic shock. However, the researchers noted that variation in data collection and outcome definitions has limited the ability to accurately benchmark performance, conduct multicenter research and guide quality improvement efforts.

To address this gap, the Standardized EMS Metrics for Survival in Transfusion and Advanced Resuscitation (SEMSTAR) Project used a modified Delphi process to reach consensus on clinical and operational metrics. This included a survey of EMS systems, followed by three rounds of ratings by a multidisciplinary panel of 28 experts in EMS, trauma surgery, transfusion medicine and resuscitation science.

Of 208 initial data elements, 168 met consensus for inclusion, including 86 core data elements recommended for universal reporting and 82 expanded metrics for more comprehensive analysis. The framework also introduces standardized definitions for key outcomes, including hemorrhagic circulatory collapse and survival following prehospital transfusion. It draws on existing data infrastructure where possible to support implementation across EMS systems. Of the 168 data elements, 100 can be obtained from the National Emergency Medical Services Information System (NEMSIS), and an additional 30 from established trauma registries.

The researchers noted that, given the evolving nature of prehospital transfusion, expert opinions and priorities may change. However, they emphasized that the framework’s standardized elements will “serve as the foundation for measuring success, driving improvement, and providing the evidence base needed to refine protocols, justify resources and demonstrate program value” as these programs continue to expand.