By Kris B. Mamula
Pittsburgh Post-Gazette
PITTSBURGH — A North Hills EMS service can now more effectively treat patients with massive blood loss, cheating death as the new therapy spreads to other rescue agencies across Pennsylvania.
Ross/West View Emergency Medical Services began carrying units of blood on May 7 for paramedics to administer to patients with serious internal bleeding or who’ve suffered major traumatic injuries.
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Just three days later, the new therapy changed a patient’s life, said Steve Kline, interim executive director of Ross/West View EMS.
The patient was unconscious from internal blood loss and “moving toward cardiac arrest” when paramedics arrived on the scene last weekend and began giving blood, Kline said. By the time the ambulance reached the hospital, the patient’s condition had improved dramatically.
“It’s pretty exciting,” said Kline, a 30-year Ross/ West View veteran. “It’s a big topic throughout the state and there’s a big push to get it into as many hands as possible.”
Treating the real problem
Ross/West View EMS was founded in 1978 and serves a 26.3-square-mile section of Pittsburgh’s northern suburbs, including five municipalities with a combined population exceeding 50,000.
Blood had long been on paramedics’ wish list of interventions to enable them to save more lives in the field, but state regulations had only allowed physicians to administer it.
That changed in 2024 with revisions to health department rules, which allowed paramedics with additional training to give blood to patients in cases of life-threatening blood loss, Kline explained.
For decades, the standard of care for treating these patients had been to replace the lost volume with normal saline or lactated Ringers, a solution containing sterile water, sodium, chloride and other minerals. The fluids have the advantages of being inexpensive, easy to store and a shelf life that can last a year.
But there are downsides — chief among them is that neither saline nor lactated Ringers can replace hemoglobin, a protein made by the body that feeds oxygen to cells and vital organs.
That means a patient with significant trauma or internal bleeding may temporarily have normal blood pressure after a flood of Ringers or saline is infused, but still have critically poor oxygen delivery to tissues.
Treating the real problem — loss of oxygen-carrying and clotting capacity — shifted the focus to a “blood first” resuscitation philosophy among trauma centers nationwide in the past 25 years, a lesson driven home by the U.S. wars in Iraq and Afghanistan.
In fact, advancements in military medicine became a turning point in the care of serious injuries.
A 2017 study of combat casualties, for example, found that early administration of blood products improved the chances of survival.
“Among medically evacuated U.S. military combat casualties in Afghanistan, blood product transfusion prehospital or within minutes of injury was associated with greater 24-hour and 30-day survival than delayed transfusion or no transfusion,” according to the study, which appeared in the Journal of the American Medical Association. “The findings support prehospital transfusion in this setting.”
‘We’ve saved multiple lives’
Phil Nawrocki, Ross/West View EMS medical director and system EMS director, Allegheny Health Network, has a simpler view.
“We don’t bleed saline on the floor when we get injured,” he said. “Blood has been shown to improve outcomes. It’s a great step up.”
The differences in how well patients do with the administration of blood compared to fluids are stark, said UPMC emergency medicine physician Lenny Weiss, who is also the medical director of Pittsburgh EMS.
“You can see it with your very own eyes and by monitoring their vitals,” he said. “We’ve saved multiple lives.”
City of Pittsburgh paramedics have been packing blood since September as part of a cooperative program with the city’s EMS system, UPMC prehospital services and Oakland -based Vitalant, a transfusion medicine nonprofit.
Since then, blood or blood products have been administered at least 20 times in the city, Dr. Weiss said.
Only 2% to 3% of EMS services nationwide carry blood, but the number has been growing. Among the western Pennsylvania rescue agencies providing the new therapy are Baldwin EMS in Allegheny County, Mutual Aid EMS in Westmoreland County, and Washington County Ambulance & Chair.
Whole blood and packed red blood cells, both of which are transfused in the field, must be refrigerated and used within a month. Units of blood approaching expiration dates are shifted to hospitals for use by inpatients.
But it may not be practical for every EMS agency to carry blood, partly because it’s a scarce resource. Instead, plans are underway for certain agencies to serve larger geographic areas, Dr. Weiss said.
“Where we are is that blood is scarce,” Dr. Weiss said. “If everybody donated blood, we would still not have enough for clinical needs.”
Blood was certainly needed in the field on Sunday, just three days after Ross/West View EMS received authorization to administer it to critically ill patients, paramedic Isabella Frazier said.
Her crew responded to a call in neighboring Millvale, where an unconscious man was found by his brother, who called 911. His blood pressure was falling due to internal bleeding when paramedics rolled up.
Frazier alerted her supervisor, who responded with the cooler containing the blood, which was infused into the patient through a large vein.
“By the time we got to the hospital his blood pressure was within normal limits and he was talking to us, just definitely doing a lot better,” she said. “It’s wonderful.”
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