An August afternoon in 2023, Angela Martin’s cousin called with alarming news. Martin’s 74 -year -old aunt had been mutilated by four dogs while walking near her home in the rural area of Purrear, North Carolina. He was bleeding a lot from the snacks on both legs and his right arm, where he had tried to protect his face and neck. An ambulance was on its way.
“Tell him in Eliquis!” Martin said, a nurse who lived an hour by car in Winston-Salem. He knew that the thin blood could lead to a potentially deadly blood loss.
When the ambulance arrived, the doctors evaluated Martin’s aunt and then did something that few emergency medical services teams do: they gave him a blood transfusion to replace what he had lost, stabilizing his blood pressure that sank.
The ambulance took her to the local high school, and from there a medical helicopter flew her to the nearest trauma center, in Winston-Salem. He needed more blood units in the helicopter and in the hospital, but finally recovered completely.
“The whole situation would have been different if they had not given blood immediately,” Martin said. “Very well I could have died.”
More than 60,000 people In the US, he sangs up to death every year of traumatic events such as car accidents or bullet wounds, or other emergencies, including those related to pregnancy or gastrointestinal bleeding. It is a main cause of preventable death after a traumatic event.
But many of those people would probably have not died if they had received a blood transfusion immediately, trauma specialists say. In a press conference The past fall, the members of the American College of Surgeons estimated that 10,000 lives could be saved annually if more patients received blood before arriving at the hospital.
“I don’t think people understand that ambulances do not carry blood,” said Jeffrey Kerby, who is president of the ACS Trauma Committee and directs trauma and acute care surgery at the Faculty of Medicine of the University of Alabama-Birmingham Heersink. “They simply assume they have it.”
Of the more than 11,000 EMS agencies in the US. UU. Which provide land transport to acute care hospitals, only around 1% carry blood, blood, According to a 2024 study.
The term “blood deserts” generally refers to a problem in rural areas where the closest trauma center is at dozens of miles away. But heavy traffic and other factors in suburban and urban areas can also turn those areas into blood deserts as well. In recent years, several EMS agencies throughout the country have established “prehospital blood programs” destined to bring blood to injured people who could not survive the trip in ambulance to the trauma center.
With blood loss, Every minute counts. Blood helps move oxygen and nutrients to cells and keeps organs working. If the volume becomes too low, you can no longer perform those essential functions.
If someone is catastrophicly injured, sometimes nothing can save it. But in many serious bleeding situations, if the emergency personnel can provide blood in 30 minutes, “it is the best survival opportunity for these patients,” said Leo Reardon, director of the Paramedic Field Transfusion Program for the Fire Department for the Fire Department from Canton, Massachusetts. “They are in the early stages of shock where blood will make the biggest difference.”
There are several obstacles that prevent EMS agencies from providing blood. Several states do not allow emergency services staff to manage blood before arriving at the hospital, said John Holcomb, a professor in the trauma division and acute care surgery at UAB Heersink School.
“It’s mainly tradition,” said Holcomb. “They say: ‘It’s dangerous. You’re not qualified.’ But both are not true.”
In the battlefields in the Middle East, the military medical facilities operators would maintain that only nurses and doctors could do blood transfusions, said Randall Schaefer, a trauma nurse from the US army and now consult with the states about blood programs prior to the hospital.
But in combat situations, “we didn’t have that luxury,” Schaefer said. The medical staff was sometimes based on doctors who carried units of blood in their backpacks. “Doctors can make the right decisions about making blood transfusions,” he said.
A quick response made the difference: the soldiers who received blood a few minutes after injuring were four times more likely to survive, According to military research.
Civil emergency services are now incorporating lessons learned by the military in their own operations.
But they face another significant obstacle: compensation. Ambulance service payments They are based on how far the vehicles travel and the level of services they provide, with some adjustments. But the rates program does not cover blood products. If EMS responders take blood to the calls, it is usually full blood of Tither or, which is generally safe for anyone to receive or blood components: liquid plasma and packed red blood cells. These products can cost From $ 80 to $ 600 on average, according to the Schaefer study. And payments do not cover blood coolers, the liquid heating equipment and other equipment necessary to provide blood on the scene.
January 1The Medicare and Medicaid service centers began counting any blood administration during prehospital ambulance transport as an “advanced life support, level 2” (ALS2), which will increase payment in some cases.
The highest refund is welcome, but it is not enough to cover the cost of providing blood to a patient, which can be more than $ 1,000, said Schaefer. The agencies that execute these programs are paid for their own operational budgets or use subsidies or other sources.
There are blood deserts in rural and urban areas. Last August, Herby Joseph was going down the stairs in his cousin’s house in Brockton, Massachusetts, when he slipped and fell. The glass plate that had been shattered and cut through the blood vessels in its right hand.
“I saw an avalanche of blood and I called my cousin to call 911,” Joseph recalled, 37.
The ambulance team arrived in just a few minutes, evaluated it and called the team of the paramedical field transfusion program based in canton, which began to administer a blood transfusion shortly after. The program serves 30 cities in the Boston area. Since the transfusion program began last March, the team has responded to more than 40 calls, many of them related to car accidents along the interstate road ring surrounding the area, Reardon said.
Brockton has a level 3 trauma center, but Joseph’s injuries required more intensive care. Boston Medical Center, the level 1 trauma center where the EMS team was taking Joseph, is about 23 miles from Brockton, and depending on traffic can take more than half an hour to get there.
Joseph received more blood at the Medical Center, where he remained for almost a week. Finally he underwent three surgeries to repair his hand and has now returned to his warehouse work.
Although Boston has several level 1 trauma centers, the region south of the city is a trauma desert, said Crisanto Torres, one of the trauma surgeons who cared for Joseph.
Boston Medical Center is associated with the Canton Fire Department to operate the field transfusion program. It is an important service, Torres said.
“You can’t simply put a new level 1 trauma center,” he said. “This is a way of mitigating inequality in access to care. Buy patients.”
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