Cleveland EMS can now provide whole blood in critical, life-or-death emergencies – a new, potentially lifesaving measure adopted by what one study estimates is just 1% of EMS departments nationwide.
Cleveland EMS began administering whole blood on June 4, EMS Commissioner Orlando Wheeler said. As of Wednesday, the department has given blood transfusions to eight people.
“Within six hours of going live, we had two transfusions in the field,” Wheeler said.
Giving blood to patients quickly can save lives
A growing body of research shows that providing blood quickly – even before the hospital – can increase the likelihood of survival. In Cleveland, Wheeler believes four of the patients who received whole blood from EMS in the last two weeks might have died without it.
MetroHealth Medical System, which is providing blood to Cleveland EMS through its blood bank, said in a press release that the program could potentially decrease mortality rates by as much as 75% when used on patients that need it most.
Right now, Cleveland EMS is giving blood transfusions to people who experience traumatic injuries such as car crashes, gunshot wounds or long falls, Wheeler said.
Excessive bleeding is a major cause of death after traumatic injuries. Historically, blood transfusions had to be given at hospitals. Paramedics could only give patients saline, which lacks many of the lifesaving properties of blood, Wheeler said. That changed when the State of Ohio updated its law last June to give paramedics the power to give blood to patients.
“Every single paramedic who’s been here for any length of time has watched somebody bleed out and die in the back of their ambulance,” said Tim Sommerfelt, a paramedic and the Second Vice President of CARE 1975, the Cleveland EMS Union. “…Now, rather than just sitting there and having to watch somebody bleed out and die, we actually have the means to help resuscitate them with the treatment they need, which is a blood infusion.”
Over the last several weeks, Cleveland EMS personnel trained at MetroHealth to administer whole blood transfusions in the field, the hospital said in a press release
Cleveland is administering blood in Southeast Side neighborhoods far from hospitals
Cleveland EMS will not carry blood for transfusions in each ambulance. Instead, an EMS captain in a separate vehicle will carry the blood in a refrigerated device and respond to critical calls alongside ambulance crew tending to the patient. Currently, that captain is focused on the Southeast Side of the city. Wheeler said that’s because that area of the city has the largest number of traumatic injuries and fewer nearby hospitals that can take trauma patients.
“I would call it a healthcare desert,” Wheeler said. “They have limited resources to healthcare facilities, because most of those healthcare facilities in that area have closed.”
Dr. Craig Bates, an emergency physician and the EMS Division Director at MetroHealth, said his team is focused on ensuring the new blood transfusion program doesn’t slow a patient’s movement to the hospital. To keep the patient moving quickly, the goal is to deliver the blood to patients in the moving ambulance.
“We are very focused on making sure that we’re not delaying things at all,” Bates said. “Cleveland EMS is fast. They move very quickly. They assess and get moving. We don’t want to mess up that part of what they’re doing well. We’re just trying to give them another tool.”
But Wheeler said the city is working to add two more blood-equipped vehicles, which will add transfusion capability across the city. While the program is currently focused on treating traumatic injuries, he hopes to expand that to medical emergencies where patients are losing blood.
The program has the potential to provide one transfusion per day and up to three during the peak trauma season of the summer, Wheeler said.
Across the country, more rural and urban places are using whole blood transfusions
In the past eight years, rural and urban cities across the United States have started giving their EMS access to whole blood. Houston was a leader on it in 2017. Now, New Orleans, Austin, Washington, D.C., and San Antonio all offer the service. And at least one other city in Ohio – Sugarcreek, a small city south of Canton – began offering it this year.
The trend follows a growing body of research showing the potential for pre-hospital blood transfers to decrease mortality, both in war and in daily life. A 2017 study of U.S. military combat casualties in Afghanistan found soldiers who received blood before the hospital or within minutes of injury had a higher likelihood of survival a day and month later. A more recent study focusing on urban environments found the death of patients increased by 11% for each minute blood administration is delayed.
“There is no substitute in serious trauma for a whole blood transfusion,” Sommerfelt said. “This is the best treatment we can give them outside of performing surgery.”
Wheeler said the department is paying for the program out of its regular operating budget. He estimated the cost of blood per patient is $600 to $900.
MetroHealth to provide whole blood
MetroHealth is providing Cleveland EMS with whole blood as opposed to blood separated into parts, such as plasma or red blood cells.
Whole blood is what blood banks like the Red Cross get from human donors. But historically, it’s split up into its separate parts to treat very specific needs in medical patients, said Bates, the emergency physician.
But those separated pieces aren’t what is needed by the trauma patients Cleveland EMS is working with, Bates said.
“The simplest thing in the end is just to give back what they’re bleeding, which is whole blood,” Bates said.
This story has been updated with information from MetroHealth Medical Center and the hospital’s EMS Division Director Dr. Craig Bates.
