{
  "abstract": "Background Prehospital blood transfusion is increasingly recognized as an important early resuscitation intervention for patients with hemorrhagic shock. However, comprehensive evaluations of such programs have been limited by heterogeneity in data collection, outcome definitions, and reporting methodologies. This impedes effective benchmarking, quality improvement initiatives, research efforts, and the creation of protocols and policies. The Standardized Emergency Medical Service (EMS) Metrics for Survival in Transfusion and Advanced Resuscitation (SEMSTAR) project sought to develop consensus-driven data elements and standardized outcome definitions to facilitate consistent reporting of prehospital blood transfusion programs.Methods Initial data metrics were identified through a literature review and surveyed across US EMS systems that perform prehospital transfusions. A modified Delphi methodology was then used by a multidisciplinary panel of 28 subject-matter experts in EMS, trauma surgery, transfusion medicine, and resuscitation science. Predefined thresholds analyzed metric inclusion, classification as either core or expanded elements, and endorsement of standardized outcome definitions.Results 89 EMS systems completed the initial survey of 208 potential data elements. Of these, 193 (93%) advanced to expert review. Experts reached consensus on 168 data elements: 86 core metrics for universal reporting and 82 expanded metrics for comprehensive analysis. Consensus was also achieved on standardized definitions for hemorrhagic circulatory collapse, including stratification by pretransfusion circulatory collapse status and survival after prehospital transfusion. Wherever possible, the resulting framework draws from existing data infrastructure, including the National Emergency Medical Services Information System and trauma registry variables.Conclusion SEMSTAR establishes the first national, consensus-driven framework for standardized data collection and outcome reporting among prehospital blood transfusion programs. By defining core and expanded metrics with standardized survival definitions, this framework enables benchmarking, quality improvement, and multicenter research across diverse EMS systems. SEMSTAR adoption will enable rigorous program evaluation and support the development of a national registry to advance evidence-based care for patients with hemorrhagic shock.Level of evidence IV",
  "authors": [
    {
      "affiliations": [
        "Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA",
        "Charles Mathias Jr National Study Center for Trauma and Emergency Medical Systems, Baltimore, Maryland, USA"
      ],
      "name": "Matthew J Levy"
    },
    {
      "affiliations": [
        "Department of Fire and Rescue Services, Government of the District of Columbia, Washington, District of Columbia, USA"
      ],
      "name": "Holly O’Byrne"
    },
    {
      "affiliations": [
        "Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Kaytlin Hack"
    },
    {
      "affiliations": [
        "The Geneva Foundation, JBSA Fort Sam Houston, Texas, USA"
      ],
      "name": "Amanda Staudt"
    },
    {
      "affiliations": [
        "ESO Solutions, Austin, Texas, USA",
        "Emergency Health Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Remle Crowe"
    },
    {
      "affiliations": [
        "EMS, Harris County Emergency Services District No. 48, Katy, Texas, USA"
      ],
      "name": "Eric A Bank"
    },
    {
      "affiliations": [
        "Surgery, Univ Pittsburgh, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Joshua B Brown"
    },
    {
      "affiliations": [
        "Thompson Valley Emergency Medical Services, Loveland, Colorado, USA"
      ],
      "name": "Timothy Brown"
    },
    {
      "affiliations": [
        "Emergency Medical Services, University Hospital, Newark, New Jersey, USA"
      ],
      "name": "Armand Cayer"
    },
    {
      "affiliations": [
        "Thompson Valley Emergency Medical Services, Loveland, Colorado, USA"
      ],
      "name": "David Edwards"
    },
    {
      "affiliations": [
        "Department of Fire and Rescue Services, Government of the District of Columbia, Washington, District of Columbia, USA"
      ],
      "name": "Gabriel H Gan"
    },
    {
      "affiliations": [
        "Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Eric Garfinkel"
    },
    {
      "affiliations": [
        "Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA",
        "Emergency Medicine, David Geffen School of Medicine, Los Angeles, California, USA"
      ],
      "name": "Craig Goolsby"
    },
    {
      "affiliations": [
        "Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Frances Guyette"
    },
    {
      "affiliations": [
        "Trauma Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Ryan B Fransman"
    },
    {
      "affiliations": [
        "Surgery, University of Alabama at Birmingham Health System, Birmingham, Alabama, USA",
        "Surgery, Uniformed Services University, Bethesda, Maryland, USA"
      ],
      "name": "John B Holcomb"
    },
    {
      "affiliations": [
        "Emergency Medical Services, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA"
      ],
      "name": "Dionne Huggins"
    },
    {
      "affiliations": [
        "Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Donald H Jenkins"
    },
    {
      "affiliations": [
        "Emergency Medical Services, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA"
      ],
      "name": "Michelle Kobayashi"
    },
    {
      "affiliations": [
        "Pediatrics, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "N Clay Mann"
    },
    {
      "affiliations": [
        "Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Asa M Margolis"
    },
    {
      "affiliations": [
        "Pediatrics, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Kevin Nicholes"
    },
    {
      "affiliations": [
        "Emergency Medical Services, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA"
      ],
      "name": "Shaun Patterson"
    },
    {
      "affiliations": [
        "Critical Care Transport, Atlantic Health System, Morristown, New Jersey, USA"
      ],
      "name": "Art Samaras"
    },
    {
      "affiliations": [
        "Schaefer Consulting, LLC, New Braunfels, Texas, USA"
      ],
      "name": "Randall Schaefer"
    },
    {
      "affiliations": [
        "University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Philip Spinella"
    },
    {
      "affiliations": [
        "Emergency Medicine, Sibley Memorial Hospital, Washington, District of Columbia, USA"
      ],
      "name": "David Vitberg"
    },
    {
      "affiliations": [
        "Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Christopher M Wend"
    },
    {
      "affiliations": [
        "Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA",
        "Los Angeles County Department of Health Services, Los Angeles, California, USA"
      ],
      "name": "Kelsey Wilhelm"
    },
    {
      "affiliations": [
        "Emergency Health Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Christopher Winckler"
    },
    {
      "affiliations": [
        "Emergency Medical Services, University Hospital, Newark, New Jersey, USA",
        "Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA"
      ],
      "name": "Tung-Lin Jesse Yuan"
    },
    {
      "affiliations": [
        "Emergency Medicine, Michigan State University, Grand Rapids, Michigan, USA",
        "EMSMD PLLC, Grandville, Michigan, USA"
      ],
      "name": "Jon Krohmer"
    }
  ],
  "title": "Establishing the Standardized EMS Metrics for Survival in Transfusion and Advanced Resuscitation: the SEMSTAR project",
  "uid": "cbbc9291-01f5-5920-9884-cb3f5c237521"
}