First-Ever Field Blood Transfusion Saves a Shooting Victim: Temperature Monitoring Support

The intervention was crucial for a patient who had sustained multiple

gunshot wounds and was in severe shock, rapidly losing blood.

En Route Blood Transfusions Save Lives, Require Simple Temperature Monitoring to Protect Blood Supply

A Life Hanging in the Balance

More than 80 individuals have emerged as survivors of shooting incidents in Indianapolis this year alone, according to the Indianapolis Metropolitan Police Department.

Yet, one particular case stood out from the rest.

The patient was in critical condition, experiencing severe blood loss and shock, pushing the boundaries of survival.

Paramedic Recollection and Response

Paramedic Bruce Tilson, who administered the transfusion, described the patient's dire state: conscious but with dangerously low blood pressure and signs of internal bleeding.

Despite having seen similar cases before, the paramedics realized that standard procedures would not suffice.

The quick thinking and skilled actions of the Indianapolis EMS team were crucial in stabilizing the patient, who had lost over a liter of blood and the time for survival was dwindling.

"We've done four transfusions,” Tilson said. “This was the first one to be successful." 

Innovative Collaboration for Emergency Care

The partnership between IEMS and Eskenazi Health, established in 2022, has been instrumental in equipping paramedics with the necessary training, tools, and blood supply for on-scene transfusions.

In this instance, a designated IEMS ambulance, equipped with a life-saving blood supply, played a pivotal role in this unprecedented rescue.

A Monumental Achievement

Paramedic Anthony Garcia shared the profound impact of being part of this historical moment for Indianapolis EMS.

The initiative utilizes military-grade technology for blood storage and warming, ensuring immediate readiness for transfusion, a practice praised by IEMS Medical Director Mark Liao for its adaptation from military to civilian medical use. The process requires temperature monitoring technology that can work remotely to ensure blood is stored at the appropriate temperature when it's needed. 

The Importance of Blood Donation

This successful case underscores the critical need for blood donations.

Liao emphasized the life-saving potential of such contributions. The initiative not only showcases the potential for innovation in emergency medical services, but also highlights the community's role in supporting these life-saving efforts.

Liao reiterated the importance of these programs in revolutionizing emergency care, especially in communities distant from medical facilities.

A Call for Expansion and Awareness

The Pre-hospital Blood Transfusion Initiative Coalition highlights that blood loss is the foremost cause of preventable deaths among trauma victims.

This successful intervention by Indianapolis EMS is seen as a beacon for the expansion of field transfusion programs nationwide.

With the push to equip more EMS organizations with this life-saving capability, the hope is that survival rates across the country will see a significant increase. 

This incident in Indianapolis serves as a harbinger of hope and innovation, demonstrating the life-saving potential of advanced medical practices and the power of community support through blood donation.

A prehospital blood transfusion is when medical personnel, such as paramedics or emergency medical technicians (EMTs), provide blood to a patient at the scene of an emergency rather than waiting until they reach a hospital.

According to a report in EMS World, a leading publication in the field, “exsanguination remains the leading cause of preventable deaths among trauma victims, with nearly half of these patients dying in the prehospital setting. And data shows for every one-minute delay in prehospital resuscitation there is a two percent increase in the odds of 30-day mortality.

In a recent position statement, the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians said that all patients with exhibiting hemorrhagic shock should receive blood products whenever available.

Similary, the International Association of EMS Chiefs issued a statement in which it said:

“Pre-hospital paramedic blood transfusion programs are now critical to improving the immediate medical response to severe injury resulting in blood loss in America,” the IAEMSC said.

“Prehospital resuscitation with blood or plasma holds the potential to change the calculus for resuscitation in the field by EMS, given the fact that the “golden period” is often a decisive factor in patient survival. When major trauma results in severe blood loss, using crystalloid fluids like saline for initial resuscitation may be doing more harm than good.

“Modern blood product transfusion has been the standard of care therapy for replacing acute blood loss resulting in clinically-significant hypoperfusion for almost 100 years.”

Prehospital transfusions are important for a few reasons:

• Reduces blood loss: In severe cases of bleeding, especially from trauma, getting blood into the patient's system quickly can be critical for survival. Every minute of delay can worsen the outcome.
• Improves outcomes: Studies suggest prehospital transfusions can improve a patient's chances of survival, particularly in situations where transport to a hospital takes a long time.

Expands treatment options: Not everywhere has readily available blood products in hospitals, so prehospital transfusion can be a critical stopgap measure.

It's important to note that prehospital transfusions aren't always a given. 

Deciding who needs one requires careful assessment by medical professionals and isn't without risks. However, research and practice are evolving to make prehospital transfusions a more viable option in critical situations.

EMS providers looking to support a prehospital blood transfusion program should ask questions across several key areas:

Program Development and Implementation:

• Medical Oversight and Protocols: Who is the medical director overseeing the program? What are the established protocols for identifying patients who need a transfusion and the types of blood products used?
• Training and Competency: What training will be provided to EMS personnel on blood storage, handling, and transfusion procedures? How will competency be assessed and maintained?
• Logistics and Equipment: How will blood products be stored and transported on ambulances? Is there equipment available to maintain proper temperature and ensure safe administration? Sonicu today provides mobile-friendly, affordable temperature monitoring solutions ideal for EMS interested in adopting pre-hospital transfusions. 
• Quality Assurance and Data Collection: What mechanisms are in place to track blood product usage, monitor for complications, and evaluate program effectiveness?

Operational Considerations:

• Reimbursement: How will the program be reimbursed for blood products and the additional costs associated with storage and administration?
• Blood Availability: What is the plan to ensure a reliable supply of blood products, especially considering potential expiration dates?

Liability Concerns: Are there any legal or liability concerns associated with prehospital transfusions that need to be addressed?

Collaboration and Integration:

• Hospital Coordination: How will communication and coordination with receiving hospitals occur regarding prehospital transfusion decisions and patient handover?
• Community Outreach and Education: Is there a plan to educate the public about the potential benefits of prehospital transfusions?

Additionally:

• Program Evaluation: How will the program's success be measured? Are there established benchmarks or goals for patient outcomes?
• Expansion and Sustainability: What are the long-term plans for expanding the program's reach and ensuring its sustainability?

By asking these questions, EMS providers can gain a comprehensive understanding of the prehospital blood transfusion program and how they can best support its implementation and success.