A growing practice among emergency responders is getting life-saving blood transfusions started before a patient arrives at an emergency room.
“Pre-hospital transfusions” are possible by outfitting emergency vehicles with specialized equipment to cool blood for storage and warm it for use. The EMS teams typically carry the blood as separated red blood cells and plasma.
“This is a growing area in emergency medical services,” said Kirby Winn, public relations manager for the nonprofit blood center ImpactLife. “But because, obviously, it relates to blood itself and the provision of the blood on those ambulances, both ground and air ambulances, blood providers are involved as well.”
ImpactLife provides the blood supply for many hospitals and emergency responders across the Midwest. In Peoria, the agency works with OSF HealthCare to make pre-hospital transfusions possible on Life Flight helicopters.
Adam Hagar is the deputy chief of the Mehlville Fire Protection District in South St. Louis. Hagar’s EMS squad is one that’s begun utilizing emergency pre-hospital transfusions. Prior to having access to actual blood products, he said paramedics would use saline solution.
“In layman’s terms, it’s effectively saltwater. It doesn’t carry oxygen. It doesn’t do all the wonderful things that blood does,” Hagar said. “But it does sometimes temporize people to allow them to survive to the hospital.”
Now, Hagar’s teams can administer a transfusion of one part red blood cells and one part plasma, the same standard used in trauma centers. He points out that emergency transfusions in the field are far from entirely unheard of.
“The picture I always show people when we’re talking about this is a picture of an Army medic on Omaha Beach on D-Day providing a blood transfusion,” Hagar said. “Since that time, nearly 80 years ago, the safety profile has improved significantly, access to blood has improved significantly, but the practice isn’t new.”
Dr. Daniela Hermelin is ImpactLife’s chief medical officer. She said advancement in the way blood is gathered and administered has decreased the risks of emergency transfusions like these.
“When we transfuse things very quickly, especially things that are cold, it can cause hypothermia,” Hermelin said. “However, as deputy chief mentioned, they use blood warmers when they transfuse products.”
There are other reactions that can occur, depending on the patient, but these are scenarios that can just as easily happen in the emergency room. Still, Hermelin says the EMS teams are prepared.
Hagar said the benefits of the pre-hospital transfusions are linked to shorter hospital stays, better patient outcomes and more efficient use of an always-limited supply of donated blood.
It varies from department to department, but emergency transfusions in the Mehlville Fire Protection District don’t add additional cost for the patient either.
“Those funds are provided by our taxpayers,” Hagar said. “They believe that the costs associated with the program, when they quantify it, the cost is worth the associated benefit for our district residents and visitors. They elected to fund it from our general fund.”
Hagar acknowledged this is still a relatively new model and it won’t be the same everywhere. He sees the implementation and reimbursement as the largest hurdles to make the practice widely available.
However, there already is significant use of pre-hospital transfusions.
“We currently have 18 bases that we supply blood,” Hermelin said. “And that covers our region. So that’s including Illinois, Iowa, Wisconsin and Missouri. So we are spread out.”
