For patients with severe blood loss – maybe they’ve been in a car crash, or become a gunshot victim – every minute counts.
“They need blood, at the end of the day,” said Tia Olson, a paramedic field supervisor with ambulance company AMR Hartford.
It used to be that first responders would administer saline and rush the patient to the hospital for a blood transfusion.
In recent years, though, more and more EMS agencies around Connecticut, and the country, are bringing blood to patients in the field to get the transfusion process started as soon as possible.
“You give it, and within a minute to two minutes, they wake back up, their vitals start stabilizing, you see the color return to their skin,” Olson said. “You see the patient go from pretty much almost near death to back alert, starting to have normal vitals.”
AMR Hartford first adopted the practice back in August 2020 in partnership with Saint Francis Hospital in Hartford. Dr. John Pettini is the EMS medical director at Saint Francis and chief of EMS for Trinity Health of New England.
“It’s probably the biggest game changer in trauma, in prehospital care ever,” Pettini said.
Pettini said the practice of in-the-field blood transfusion was pioneered by the military, who found it greatly improved survival rates for those injured in war zones during the Iraq and Afghanistan conflicts of the 2000s.
“They called it ‘Jesus juice,’ because it seemed to raise the dead,” Pettini said. “You give it and it’s just dramatic.”
Now, Saint Francis partners on prehospital blood programs with AMR, the Granby Ambulance Association, and Enfield EMS. Through those partnerships, Pettini said, roughly 300 patients have received prehospital transfusions. On Thursday, with Pettini’s assistance, Saint Mary’s Hospital in Waterbury also launched a prehospital blood program, with Trinity Health of New England EMS.
Pettini said prehospital blood programs can make a difference regardless of geography: patients in urban, rural and suburban settings all benefit.
“If we spend a couple more minutes on scene, that means that the blood’s going in, it’s actually better for the patient. The minutes matter. It decreases mortality,” Pettini said. “For every minute transfusion’s not started in severe hemorrhagic shock, mortality increases.”
A growing practice
According to the Office of EMS at the National Highway Traffic Safety Administration, roughly 2% of the nation’s 15,000 EMS agencies have prehospital blood programs. But that number is growing rapidly, thanks in no small part to the federal agency’s investment in the programs.
“If I had a magic wand, I would be looking to make this available to any EMT agency that’s interested,” said Jonathan Morrison, NHTSA administrator.
NHTSA recently awarded $50 million for ambulance services across the country to stand up or expand prehospital blood programs, everywhere from rural Oregon to Tampa, Florida. In Connecticut, $4.7 million of that is being split between the Capitol Region Council of Governments and the town of Suffield.
“It’s a big deal,” said Suffield Volunteer Ambulance Association Chief of Service John Spencer. “The quicker that we can get a blood transfusion onboard to a traumatic injury that already has bleeding, the better outcomes they're going to have.”
Morrison cited a figure from an American College of Emergency Physicians policy statement that resuscitation with prehospital blood could reduce mortality in certain patients by 37%.
“There’s not too many tools we have in the tool box that can save thousands of lives, potentially, each year,” Morrison said. “We think this is one of them.”
‘A game changer’
The blood used in the transfusions is type O, which patients of all blood types can safely receive. It’s sourced through the American Red Cross. The supply relies on donors.
“I think the biggest thing is getting the word out there that there is blood in the community,” said Olson, the paramedic field supervisor. “The more that the community knows about it, the community can give back by donating blood so that it is relatively available for them or their family members.”
The technology isn’t without its limitations. Blood has to be kept cooled at the right temperature, but warmed before it’s given to a patient. And it expires, so there has to be a ready supply. There are also regulatory hurdles.
But for Miles Garrison, another paramedic field supervisor with AMR Hartford, it’s a tool he says has made a real difference in patient outcomes.
“I think it’s a game changer for trauma, especially here in the city,” Garrison said. “If we can get the blood in as fast as we can, administer it to them, that gives them more time to stay alive, to get to the hospital.”
Pettini, the EMS chief, agrees.
“We see unexpected survivors,” Pettini said. “We’ve had a few here where based on the injury pattern that we saw, normally we would not have expected this person to survive, yet they survived. And it’s the patients that received the blood in the field.”
