Pa. EMS director develops Quick Response Service to get blood on scenes fast
The ground-based mobile blood transfusion team is dispatched when an EMS agency requests it
By Wes Venteicher
The Pittsburgh Tribune-Review
MONROEVILLE, Pa. — Two years ago, a man trapped under a 16-ton construction vehicle within eyesight of Forbes Hospital in Monroeville needed a blood transfusion.
A physician driving an emergency medical vehicle responded within moments of being called, but the vehicle — like nearly every emergency vehicle in the state — wasn't equipped to deliver blood. The driver, Dr. Daniel Schwartz, waited about 30 minutes for a helicopter whose crew could perform a transfusion.
The construction worker survived, but several gunshot and car crash victims in the past few years have not, said Schwartz, the EMS medical director of Forbes Prehospital Services. To try to save more lives, Schwartz developed a ground-based mobile blood transfusion team, one of the first in the state.
“There's a need for it across the entire state,” he said. “There's a need for it in this region.”
Pennsylvania law forbids paramedics from administering blood, requiring a physician or specially trained nurse to perform transfusions, according to the state Department of Health.
Schwartz and another Forbes physician respond with what is known as a Quick Response Service vehicle, carrying blood packs that are kept at Forbes. The unit, a Jeep Cherokee called MD951, can reach patients when weather or logistics impede LifeFlight and STAT MedEvac crews, Schwartz said.
Since it began over the summer, the unit has responded three times with the blood packs, Schwartz said. He administered blood to a 59-year-old Penn Hills woman who was bleeding from a head laceration after a car struck her in her front yard, according to an Allegheny Health Network spokeswoman.
Schwartz, 43, an Army Reserve doctor, said he adapted ground-based transfusion from the military, where it is common.
“If there's a way to make that resource available in the civilian setting, it's something we wanted to look into,” he said.
Generally, Schwartz said, a transfusion might be warranted if a trauma patient's trip to the hospital will be more than 10 minutes. He said his unit is available to respond anywhere mobile transfusion might make sense, in Western Pennsylvania or even in neighboring states, when other agencies request it.
The unit carries type O-positive blood, the standard for trauma response.
The unit is not automatically dispatched, Schwartz said. The Monroeville Fire Department, the city's primary EMS agency, is dispatched when people call 911. Schwartz's unit responds when other agencies request it.
Having a physician dedicated to emergency medical response is rare in Pennsylvania, said Richard Gibbons, director of the Bureau of EMS for the state Department of Health.
But it provides a “needed level of service,” especially in areas where harsh weather conditions hamper air transport, Gibbons said.
The state has created a “critical care” designation that makes it easier for primary EMS units — such as the Monroeville Fire Department's — to perform blood transfusions with a physician or nurse on board, he said. So far, only Superior Ambulance Service in Mercer County has obtained the designation, he said.
“I believe we will see, as they get personnel trained to the level that is required … more agencies seeking that level of licensure,” Gibbons said.
Forbes is beginning a program in which one to three nurses with prehospital training would be available to perform the transfusions, extending the Quick Response Service's reach, Schwartz said.
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