It’s estimated that up to 30% of trauma patients die due to bleeding out. That means it’s preventable if we Stop The Bleed and replace the blood.
In August of 2016, when CCEMS became one of just two ground EMS systems in the entire country to carry Packed Red Blood Cells and Plasma in the field 24/7/365. The other was our partner in the program, Harris County ESD 48 Fire/EMS in west Harris County.
A handful of others around the country had access to blood products on an as-needed basis.
A year later, in August of 2017, CCEMS and ESD 48 became the first ground EMS systems in the country to carry Whole Blood. ESD 48 had the first documented case for a medical patient. And, in October of 2017, CCEMS made history with the first-ever use of whole blood on a trauma patient in the field. The news resonated through the EMS community worldwide and made big news in EMS publications.
Why is carrying Whole Blood important?
Because a person with a compromised artery can bleed out and die in as little as three minutes. It doesn’t matter whether it is from a medical condition, shooting, a stabbing, car wreck, industrial or home accident, or a fall, controlling the bleeding and then replacing the blood in the field is a game-changer. Blood products (packed red blood cells and plasma) take longer to administer and does not include platelets, a critical component in clotting.
The use of Whole Blood in prehospital resuscitation is the next essential step in combating preventable deaths due to blood loss. Waiting to transfuse Whole Blood until they arrive at the hospital significantly increases mortality.
The American Association of Blood Banks is a professional society for transfusion medicine which sets the standards for hospital transfusion services. In April 2018, the AABB amended their standards to indicate it is permissible to use low titer group O Whole Blood for recipients of known or unknown ABO group types.
Blood Suppliers
In 2016, we partnered with Gulf Coast Regional Blood Center to provide the blood products (type O negative Packed Red Blood Cells and Fresh Plasma). It was a new type of business for them to have an EMS agency as a client compared to a hospital.
In August 2019, CCEMS transitioned from Gulf Coast Regional Blood Center to the South Texas Tissue and Blood Center (STTBC) in San Antonio, TX. The decision was made based on the life-span of the Whole Blood they provide and their solution to the supply and demand challenge. STTBC uses a special bag and citrate preservative that extends the life-span of Whole Blood from 21-days to 35-days. The additional 14-days is significant to avoid the blood expiring before being administered. The blood is shipped overnight via FedEx in a special cooler.
The South Texas Blood and Tissue Center has identified a donor base of male, O Positive, Low Titer, donors and have them on a regular donation schedule. The Brother’s In Arms program taps into their veteran population and keeps them in a steady supply of this new universal donor type. They are partnering with CCEMS to start a similar program here in Houston identifying a base of First Responders and Veterans. CCEMS and South Texas Blood and Tissue Centers will schedule regular donor events in the area to identify these essential donors and get them on a regular schedule.
Coolers and Carrying Methods
CCEMS uses the Crēdo™ ProMed cooler with Pelican biothermal tic-panels. The box is built with using frozen panels inside of an insulated liner. The box will maintain 2-6 degrees Celsius for 24-hours. The panels are then switched out with a second set for the next shift. The size of the box will carry two units of Whole Blood and a temperature probe that is remotely monitored from the driver’s position in the response vehicle. An alternative solution is the Blood Boxx, made by Combat Medical Systems. It comes in various sizes to include custom sizes to fit your deployment needs.
Warming Methods
CCEMS started off using the Buddy Lite fluid warmer. It was what the air medical provider was using, and it made sense for easy patient transfers. Then, a new warmer entered the market. The QinFlow Warrior out-performed the Buddy Lite. It maintains the temperature at high flow rates, something that was a challenge for the competition.
Quality Improvement
CCEMS has transfused more than 200 units of Whole Blood and has affected positive patient outcomes, mitigating preventable death due to blood loss. Each patient chart is reviewed for quality improvement, and the clinical data is evaluated. The data show a measurable improvement in shock indexes in patients receiving Whole Blood compared to Packed Red Blood Cells and Plasma or no blood at all. For more information on our whole blood program email us at blood@ccems.com
