Julie Washington
cleveland.com
CLEVELAND, Ohio — When someone is losing blood from a gunshot wound or serious car crash, minutes count.
Now, Cleveland trauma victims have a better chance of survival, thanks to new initiatives aimed at administering whole blood transfusions before patients arrive at the emergency department’s doors.
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Cleveland Emergency Medical Services paramedics and MetroHealth System are collaborating on a program to administer whole blood transfusions to patients at accident sites and on the way to the hospital.
Cleveland is the first major city in Ohio with an EMS on-scene blood transfusion program, which could decrease trauma mortality rates by as much as 75%, the city said.
The program aims to treat traumatic injuries that result from gunshot wounds, stabbings, high-velocity motor vehicle collisions and falls from a significant height.
Sugarcreek in Tuscarawas County rolled out a similar program earlier this year.
Pittsburgh , New Orleans and several cities in Texas also have similar initiatives, said Cleveland EMS commissioner Orlando Wheeler . These cities have seen a significant decrease in mortality from traumatic injuries.
Cleveland’s new initiative is already saving lives, officials say.
During the program’s first three weeks since starting in early June, EMS paramedics gave about 10 transfusions to critically ill patients on the city’s southeast side, said Dr. Craig Bates, EMS division director for MetroHealth’s department of emergency medicine. Seven of those patients survived and three died.
“So far it is looking very promising,” Bates said.
“There is growing evidence — and the military has known this for awhile — that whole blood is the optimal resuscitation device for critical trauma patients,” Bates said. “It helps with their blood clotting, it helps with oxygen-carrying capacity, it helps address all of the problems that those patients have when they’re very sick.”
A 2024 study of one urban EMS system suggested that the rate of death increased 11% with each minute that passed between an injury and a blood transfusion. One-scene blood transfustions resulted in patients receiving blood as mucha s 19 minutes sooner, making them four times as likely to survive, according to research led by Tulane University School of Medicine in New Orleans .
The Cleveland program costs about $625 per transfusion, including blood and equipment, the city said.
The program was expected to expand citywide by early July, following an initial pilot period in the southeast section of Cleveland .
It started in that area of the city because it has high rate of severe trauma patients, and much longer transport times to reach a hospital, Bates said.
Cleveland’s southeast side also is an underserved area in terms of health care, Wheeler said. There are no Level 1 trauma centers — hospitals able to handle the most complex trauma cases — in that neighborhood. MetroHealth and UH are the only Level 1 trauma centers for adult patients in the city, Wheeler said.
In the past, state law barred EMS paramedics from giving blood transfusions, Wheeler said.
Instead, paramedics gave patients transfusions of saline to prevent dangerously low blood pressure. But whole blood is better in crisis because it transports oxygen molecules to tissues and contains clotting properties, two things that help stabilize badly injured victims, Wheeler said.
In June 2024 , the state added blood transfusions to the list of procedures that paramedics can perform. Cleveland EMS seized the opportunity and partnered with MetroHealth to train paramedics to administer whole blood transfusions at trauma scenes, Wheeler said. MetroHealth also leases blood coolers and warmers to the city as part of the program.
Wheeler believes that rapid whole blood transfusions are something the city owes its citizens.
“The reality of it is, we can’t stop motor vehicle collisions,” Wheeler said. “We can’t stop people from being shot or stabbed or severely beaten. But it’s what we do after that, I believe, that makes a difference.”
How it works
While the universal blood type is O-negative, it’s in short supply. The EMS program uses only O-positive blood obtained from the American Red Cross .
Most patients won’t have an allergic reaction to O-positive blood, Wheeler said.
Blood is stored at 36 degrees, and is warmed to body temperature as it’s being transfused.
EMS captains, who are on-duty for every shift, will carry whole blood in a Metro Life Flight cooler installed in their vehicles, Bates said. If a patient needs blood, the EMS crew will call for the captain to meet them at the scene, or meet the ambulance along the route to the hospital at predetermined rendezvous points, Bates said.
Initially, pre-hospital transfusions will only go to patients who are the sickest of the sick, Bates said, although the program may be expanded to other patients in the future.
EMS operates 25 units located throughout the city, and has three supervisors overseeing three city zones.
If a second trauma incident were to happen when the supervisor was at a trauma scene, the second accident would not receive blood, Wheeler said.
Cleveland EMS also will begin using other new life-saving devices this summer, Wheeler said. They include mechanical CPR devices that can perform chest compressions on patients in cardiac arrest, and portable ventilators that will help patients breathe.
Both will be deployed on all ambulances, allowing paramedics to concentrate on other types of patient care, Wheeler said.
In addition to Cleveland EMS and MetroHealth’s efforts, University Hospitals recently announced a collaboration in which SWAT medics can administer blood to wounded people at the scene of a shooting.
The UH program is believed to be the first of its kind in Ohio , the health system said in a press release.
The Westshore Enforcement Bureau SWAT team now has access to units of blood they take with them when called to a scene. It is made up of police officers and firefighter-paramedics from Bay Village , Fairview Park , Lakewood , North Olmsted , Rocky River and Westlake , who deal with high-risk situations such as hostage standoffs or arresting someone considered armed and dangerous.
“When someone has uncontrolled internal bleeding, giving blood can help keep them alive long enough to get hemorrhage control at the hospital,” said SWAT Team medical director Dr. Jordan Singer . “Rather than wait to get them to the hospital to get blood, this gives it to them in the field as close to the time of injury as possible.”
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