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Use of whole blood grows across Mo. despite challenges

Widespread adoption by EMS agencies faces challenges due to equipment purchases and insurance


A Cole County EMS ambulance.

Cole County EMS/Facebook

By Michele Munz
St. Louis Post-Dispatch

ST. LOUIS COUNTY, Mo. — Bobbie Bush was expecting to find her husband dressed and ready after returning from her errand. Instead, she said, she found him slumped on the floor of their bathroom in a pool of blood. His skin was gray, and he could barely speak.

A varicose vein had ruptured in his leg, and blood thinners he was taking had exacerbated the bleeding.

Luckily, the ambulance crew from Mehlville Fire Protection District that responded had just begun carrying blood on its vehicles. Paramedics were able to give Harry Bush, 82, an immediate transfusion. He stayed just one night in the hospital.

“Had he not gotten transfusion right away he might not have ever recovered,” his wife said.

For decades, emergency responders have used saline solutions instead of blood products to treat patients with dangerous blood loss. The solution is cheap and easy to store.

But a growing body of research is showing that patients do better when transfused with whole blood or blood products such as plasma and red blood cells instead of the saline, especially when miles away from a hospital.

One study found up to 5% increased likelihood of dying for every minute of delay in access to blood after a serious trauma.

Patients quick to receive blood also tend to not need as much blood after they arrive at a hospital, thus saving a precious commodity, and have shorter hospital stays.

“It is really much a win-win in every way,” said Dr. Daniela Hermelin, chief medical officer for Impact Life, which provides blood products to providers in Missouri, Illinois, Iowa, and Wisconsin.

Saline solutions simply cannot carry oxygen, ensure clotting or maintain the body’s salt-to-water balance like blood.

“It intuitively makes sense, but now we are showing through scientific and medical academic collaborations, that this actually saves lives,” Hermelin said.

Nearly a year ago, because of the growing evidence, the International Association of EMS Chiefs called on every emergency medical service system in the U.S. to “urgently prioritize” the implementation of prehospital blood transfusion programs.

[RELATED: IAEMSC calls on EMS systems to adopt prehospital blood transfusion programs]

However, big challenges are preventing widespread adoption. The service requires the purchase of refrigeration, warming and transfusion equipment along with training. It is also not covered by insurance, which means providers must foot the bill.

Mehlville is just one of three ambulance crews Impact Life partners with who are providing transfusion to patients. The others are Cole County Emergency Medical Services and Washington County Ambulance District in Missouri.

In addition, Impact Life officials say more than a dozen helicopter crews in Illinois, Indiana and Iowa also provide blood transfusions in the field.

Cole County EMS was the first in Missouri to begin arming its first responders with blood products about a year ago because many of its residents were 35 minutes or more from the nearest hospital able to treat serious trauma, said Chief Eric Hoy.

Arming first responders with blood products could save 40,000 to 60,000 lives a year, some experts estimate. Trauma is the leading cause of death for people under the age of 65, with many bleeding to death before they reach a hospital.

Mehlville Deputy Chief Adam Hagar saw firsthand how much the immediate transfusion helped Harry Bush in February.

“It was remarkable. His vital signs stabilized. His color improved. His mental status improved. Frankly, everything got better,” Hagar said.

While immediate blood transfusions can improve the outcomes of those seriously hurt in shootings, stabbings, car crashes or work accidents, Hagar said they can also help in cases of “medical bleeding” that are the results of disease or complications after childbirth or surgery.

To help spur more providers to adopt the practice, the national organization of EMS leaders encouraged collaboration among EMS leaders with trauma surgeons, emergency physicians and blood banks to quickly develop standard protocols and procedures to safely provide blood transfusions to patients before they get to hospitals.

Hermelin with Impact Life said the National Association for the Advancement of Blood and Biotherapies is “very close” to publishing its standards and guidance for providers in transporting, storing and transfusing blood products.

In the meantime, Impact Life is working closely with its EMS partners in education and implementation, which Hagar said was critical in implementing Mehlville’s program.

Hagar said there is a “tremendous amount” of interest among St. Louis -area EMS crews in providing blood transfusion. He expects more to begin providing the treatment as soon as they work through protocols and costs.

He’s thankful, he said, as the largest fire district in the county, that Mehlville is funding the service out of its general fund. About $25,000 was budgeted for the program this year, which included more than $17,000 to purchase refrigeration and warming equipment.

Dr. Joseph Finney, Washington University emergency medicine physician at St. Louis Children’s Hospital, said that as more people receive blood transfusions before they even get to the emergency room, research will continue to confirm the benefit.

“I am personally excited about the future of this possibility,” Finney said, “and I think it’s going to help save a lot of lives down the road.”

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