What Every Paramedic/ED team needs to know about blood use for Jehova's Witness'

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This week's Coffee and Cases session delivered a deeply respectful and practical discussion on caring for Jehovah’s Witness patients who refuse blood products on religious grounds. It was one of the most insightful sessions we’ve had on bridging ethics, evidence, and emergency medicine.

Here are the biggest takeaways for prehospital and critical care providers in SA:

This is not about refusing care—it’s about values. Jehovah’s Witnesses want the best possible care without the use of whole blood or its four primary components (RBCs, WBCs, plasma, platelets). Many will accept fractions (albumin, clotting factors), autologous options (like cell salvage), and volume expanders, but only if informed consent is possible.

The DPA Card is everything. If the patient is unconscious, their Durable Power of Attorney card (which many carry) outlines what treatments are acceptable and who can speak for them. If no card is found and there’s no ID, treat as per your usual emergency protocols, you won’t be held liable.

Early intervention saves lives—even without blood. Some studies showed that system-wide bloodless care strategies reduced transfusions by over 40% and improved outcomes. Trauma teams in a well known JHB facility managed a complex case with broken neck, shattered femur, and internal bleeding, all without blood, by staging surgeries and supporting hematopoiesis.

Your toolkit:

• Minimise blood loss: TXA, direct pressure, haemostatic agents
• Support erythropoiesis where possible (later in the care): iron, B12, folate
• Enhance oxygen delivery: high-flow O₂, fluid resus
• Respect consent: discuss autologous options like cell salvage (when feasible)

There’s help. The Hospital Liaison Committee (HLC) offers 24/7 support to clinicians, including connecting you to cooperative doctors and strategies.

Final thought: We’re not just treating haemoglobin, we’re treating human beings. Respect for belief is not a barrier to excellence. It’s a bridge.

➡️ Have you ever managed a patient who refused blood? What did you learn?

#CriticalCare #PrehospitalMedicine #EthicsInMedicine #JehovahsWitness #BloodlessMedicine #TraumaCare #SouthAfricaEMS