Victoria’s Emergency Medical Services can now provide whole blood to trauma victims, a dramatic upgrade from options that were previously available to patients who had suffered severe blood loss.
Whole blood is natural blood from a donor that has not been separated. Before Tuesday, Victoria’s ground ambulances only carried saline solution and did not have any blood components for transfusions.
“Most EMSs don’t carry blood products (at all), so to move to whole blood is to become as modern as it gets at the moment,” said Dr. Mark Yazer, an expert on whole blood and a pathology professor at the University of Pittsburgh. “Your city certainly is on the forefront of implementing whole blood.”
Tim Hunter, the battalion chief for the Victoria Fire Department, said it was a simple decision for Victoria’s emergency medical team to begin using whole blood. The fire department began considering the switch to whole blood about a year ago, when Hunter, Chief Tracy Fox and Dr. John McNeill, the medical director of Victoria’s EMS, learned about successful whole blood programs in other cities at a conference about active shooters. Since then, the department has been working to get the right equipment and access to the right type of blood donations to begin using whole blood.
“It just works better. It’s less complicated, and when people bleed they don’t just bleed plasma or red blood cells, they bleed whole blood,” Hunter said. “It uncomplicates a whole lot of issues.”
Victoria’s EMS received its first unit of whole blood Tuesday, and will be stocked with two units at a time by the end of the month, Hunter said. The units will be stored with the EMS captain on duty, who will respond to any critical calls where a blood transfusion might be required. All of Victoria’s six ambulances are now equipped with a machine to warm the blood and prepare it for transfusion.
PHI Air Medical, the air ambulance company that serves Victoria, also began carrying whole blood in its Victoria helicopters Oct. 5. Previously, the helicopters were stocked with red blood cells and blood plasma.
Although using whole blood was the standard of care in to treat soldiers during most 20th century conflicts, medical thinking gradually shifted away from using unseparated blood, instead recommending that patients be given blood that had been separated into two of its major component parts: red blood cells and blood plasma. Now, research is suggesting that whole blood may be the best option, and the medical field is reversing course.
Blood transfusions are critical for patients who have lost lots of blood, say from a car crash or a gunshot wound, or patients who have suffered internal bleeding. Getting blood into patients as quickly as possible is essential because blood loss is one of the quickest ways to die, Yazer said. But most EMS systems don’t carry blood products, and if they do, they usually don’t carry whole blood.
Research has shown that patients who receive both red blood cells and blood plasma have a greater chance of surviving trauma that patients who receive saline alone, Yazer said. But giving patients red blood cells and blood plasma separately is logistically challenging for EMS systems and for surgeons in the operating room.
“Whole blood solves that problem entirely by providing all the components in one bag,” Yazer said.
To date, researchers haven’t done any randomized, clinical trials looking at whole blood’s effect on the mortality of civilian trauma victims, Yazer said, although he and his colleagues in Pittsburgh are conducting the very first one. But research from the U.S. military has shown that quickly giving injured soldiers the multiple components allows them the greatest chance of survival.
Whole blood is still relatively new in modern U.S. medical systems. Pittsburgh was the first city to begin using whole blood for trauma patients in December 2014, Yazer said. Since then, other hospitals and some EMS systems have begun adopting it as well. In addition to his research on how whole blood affects a trauma victim’s likelihood of survival, Yazer has also surveyed American civilian hospitals about what blood products they use. In the most recent survey, 34 hospitals said they used whole blood, although there are likely other hospital systems that use whole blood that did not respond to the survey.
Although more research on whole blood is still developing, most in the field see it as a promising development. The thinking, Yazer explained, is that if plasma improves survival of trauma victims, that surely whole blood – which has red blood cells, blood plasma, and platelets, which help blood clots form – will be beneficial.
At any rate, trauma patients in Victoria will now have earlier access to blood when they need it, and getting access to any blood as early as possible has shown to help patients survive.
“I think they’re making a big step for patient safety,” Yazer said.