By Megan Guza
Pittsburgh Post-Gazette
PITTSBURGH — For more than 90 minutes on a rainy morning in 2022, Shawn Smith was trapped inside the crumpled remains of his car — he had hydroplaned along Route 51 on his way to school, sending the bright yellow Mustang spinning into a utility pole with so much force that it nearly tore the car in half.
As rescue crews carefully cut through the twisted metal to get to Mr. Smith, he was essentially dying: Along with a broken femur and shattered pelvis, he was bleeding internally. His blood pressure plummeted.
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It was the two units of blood — and a third later in the ambulance — that first responders were able to get quickly to the scene that saved him, said Dr. Lenny Weiss, a UPMC emergency physician and medical director for Pittsburgh.
Mr. Smith, then 18, recovered from his injuries. Now 21, he’s studying biology at the University of Pittsburgh. Dr. Weiss said he is living proof of the importance of being able to administer blood quickly at trauma scenes.
On Wednesday, officials celebrated the formalization of the pilot program that saved Mr. Smith in 2022. As of this week, both of the EMS Bureau’s rescue trucks now carry two units of whole blood on board at all times. Officials said those trucks already respond to most critical EMS calls, meaning the blood will likely be there and ready when the most dire patients need it most.
“What happened before we would have blood [in the field] is people would bleed out — they wouldn’t get the blood replaced by the time we got them, even swiftly, to the trauma center,” Dr. Weiss said. “This really bridges that gap.”
It took a year to finalize the contracts and formalize the program, which is a joint effort among EMS, UPMC and Vitalant. The process included purchasing and installing military-grade refrigerators in the trucks, each of which cost around $10,000. They’re equipped so that even if all power to the truck were to fail, they can maintain the needed temperature to preserve the blood for 48 hours.
The city’s Rescue 2 truck was outfitted and deployed with blood on board earlier this month. The Rescue 1 truck was deployed this week.
The change saves critical minutes that would have otherwise been spent driving to the hospital to get the blood, said EMS Division Chief Mark Pinchalk.
In the pilot program, only a physician could administer the blood, which had to be picked up from a hospital and then taken to the scene. In that regard, the program was limited mostly to cases like Shawn’s — situations where a patient in need of blood is trapped for an extended period.
In the three years of the pilot program, blood was administered at a scene 15 times, and patients survived in 13 of those cases.
“The logistics of that process were very difficult,” he said. “Everyone kind of had to be in the right place at the right time.”
If everything went perfectly, Chief Pinchalk said, the blood could make it to the scene in 10 to 15 minutes. If everything didn’t go perfect, he said, it could be 20 to 30 minutes.
That’s far beyond what in pre-hospital care is known as the “golden 10 minutes” — the concept of limiting the time a critical patient spends at the scene to 10 minutes or less.
“We want to get them off the scene and try to get them to the hospital, get them blood, get them surgery and other interventions, but blood [already on scene] extends that timeline now,” he said. “Once we get blood on board, it gives us an opportunity to kind of slow down that clock.”
While paramedics haven’t administered blood in the field since the rescue trucks were ready, the pilot program transfused blood to nine patients this year while the contracts were being finalized. Eight of them survived.
They weren’t just trauma patients, Chief Pinchalk said — two were patients with severe gastrointestinal bleeding.
“Blood pressures weren’t measurable, they were unconscious, they were near death,” he said, “and then they were resuscitated with the blood, and both of them survived.”
No blood goes to waste: As it nears the end of its lifespan, it’s taken from the rescue trucks and used in emergency departments.
“Blood is a scarce resource,” Dr. Weiss said. “We can’t waste it, and we have to protect it.”
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