By Dolly A. Butz
Sioux City Journal
SIOUX CITY, Iowa — A former Army trauma surgeon who provided life-saving care to soldiers during the Battle of Mogadishu, which inspired the movie “Black Hawk Down,” was in Sioux City last week promoting an initiative to make prehospital blood transfusions available on eligible ambulances across the United States, including in Siouxland.
Dr. John Holcomb, a retired Army Colonel and professor in the University of Alabama at Birmingham’s Division of Acute Care Surgery, sits on the Prehospital Blood Transfusion Coalition’s board of directors with Eric Bank, assistant EMS Chief of Harris County, Texas, Emergency Service District No. 48. Holcomb and Bank met with first responders, health care professionals and local leaders Wednesday. They also visited LifeServe Blood Center before sitting down with a Journal reporter.
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“It is saving lives across the country,” Holcomb said of prehospital blood transfusion. “The number of EMS agencies that are carrying blood prehospital is doubling every year. Nothing, as far as an intervention to save lives will have a bigger impact for people that are bleeding.”
Carrying blood on eligible ambulances doesn’t just improve trauma patients’ survival, Holcomb said it can save the lives of non-trauma cases, as well. He said patients suffering from gastrointestinal bleeding from cancer or bleeding from an ectopic pregnancy, for example, have a greater chance of surviving if they receive blood and/or blood components before arriving at a hospital.
Just 2% of U.S. ambulances carry blood, even though doing so could save an estimated 10,000 lives annually, according to Holcomb.
Bank said a shortage of blood donors, as well as insurance reimbursement for prehospital blood transfusion are barriers to having blood on every eligible ambulance. One of the coalition’s main efforts is to tackle the reimbursement issue, which Holcomb said is a “city, county, state, federal issue, as well as a “private insurance issue.”
“It’s not reimbursed enough to pay for the actual event. Typically, the event costs around $1,500 with a typical CMS reimbursement of around $700. So there’s a little bit of a downfall there,” Bank said. “There’s also a donor problem. We need more donors going to the blood bank.”
The coalition began laying the groundwork for ambulances carrying blood in 2014. They put component therapy, or parted out blood products onto an ambulance in 2016. Whole blood followed in 2017 in Houston .
Bank said they’ve “learned a lot” in the past decade and developed guidelines, which are available on the coalition’s website, to start up a prehospital blood program.
“All the groundwork on, ‘How do you maintain the cold chain storage? How are logistics handled? How do you heat up the blood? Where do you get it from? What products?’ — all that’s been worked out,” he said. “Folks have to take that stuff in, and then they have to customize it to themselves.”
In two weeks, Holcomb said a pilot for prehospital blood will be starting in Des Moines . He said it takes roughly two years of work to get a pilot program up and running.
“Hundreds and hundreds of Iowans a year would be alive if you did this across the entire state,” he said.
Bank estimated that initial program costs for Sioux City would be in the $75,000 to $100,000 range. Ambulances need specialized equipment, such as refrigerators and warmers, in order to carry and administer blood. He also said fire departments that want to participate need to hold blood drives.
“I always tell folks, if you’re going to be a good steward of the blood supply, then you also need to have donations at your department,” he said.
Holcomb said he and Bank have had a “good conversation” with local leaders. He’s optimistic blood will someday be available on Sioux City Fire Rescue ambulances.
“It’s an extraordinarily cheap intervention for the bang for the buck that you get. Every place in the country that’s doing this is seeing huge improvement in survival,” Holcomb said.
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