Blood loss at a trauma scene is normally dealt with by emergency responders on the spot by giving victims a solution of salt and water, closely matching the concentrations found in human blood.
But starting on Monday, the Sarasota County Fire Department in a partnership with SunCoast Blood Centers will aim to make an even closer match by providing life-saving whole blood transfusions to patients with severe bleeding or traumatic injuries before they get to the hospital.
The program will have specific Sarasota EMS personnel administering whole blood transfusions directly at the scene. The whole blood used is collected and supplied by SunCoast.
"It was started in Texas as a study to see if it would improve outcomes of trauma patients. Most people hypothesize that it would, and it actually improves their survivability rate, 60% increase in survivability if whole blood is given to the patient population that needs it," Sarasota’s Assistant Chief of EMS Operations Brian Nadler said. "We identified, through our reporting mechanisms for incidents over the last few years, four to six times a month this product would have been utilized ... on patients that needed it, just based on their blood pressures and their mechanism of injury. We think that number is going to be higher after (the program) starts on February 10."
Frank Marshall, medical director of the Sarasota County Fire Department, explained the use of whole blood: "When you bleed and you have hemorrhagic shock, which is shock secondary to bleeding, you need blood, right? So in the years past ... we've been giving normal saline, which is essentially sterile salt water, to patients who bled either into their abdomen or into their chest or bled out outside of their body, and that's not what they need. They need whole blood. They need the ability to clot. They need the ability to carry oxygen, so they don't need saline. What they need is blood. So they lost blood, they need to get blood back."
Whole blood refers to blood that remains complete, with no components like plasma removed, making it highly effective for treating patients with major blood loss.
"We have three EMS captains located in the north central and the southern part of the county, and they will be equipped with the whole blood so if there is an accident, they're going to be dispatched to that incident based on what the 911 caller says.," Nadler said. "Also, our EMS crews can call them directly on request for them to come to the scene, and they will be initiating the whole blood to the patient. And our EMS captains are advanced paramedic practitioners, so they are able to do more advanced procedures than the paramedics that are on the roads. So they will continue giving that blood in the ambulance with the regular-line paramedics on the roadway."
Delivered in a sterile, warm, and safe manner, this advanced procedure offers victims a much better chance of survival during emergencies.
"The goal is to save more lives, and it's proven in the data that it will save lives, and we're going to be following the program closely with our data technicians and analysts to determine if we are making an impact, and if we do determine that we are making an impact, we may even expand the program based on the information we receive," Nadler said.
Blood collected and supplied by SunCoast is stored in temperature-controlled, monitored medical storage devices and made available to Sarasota EMS captains. These captains can carry the blood to medical incidents, ensuring life-saving transfusions happen immediately.
Scott Bush, CEO of SunCoast, emphasized the importance of this program:
"These transfusions have been instrumental in cardiac patients making full recoveries and kept hemorrhaging patients from bleeding out. However, supplies are limited, so we must reserve this procedure for the most critical of patients."
Nicole Smith, Sarasota EMS operations captain, described how none of the blood available for the project will go to waste, even if it is not used: "What I love about this is that nothing goes to waste. So we use this for a certain time period, and then we give it back to the blood bank that allows the hospital to use it so that ... we're not sitting on it and not using it."
Smith said the blood is monitored not only on the cooler, but with tracking devices as well, helping to ensure none is wasted.
Additionally, Smith said, when personnel identify a need for the use of blood, they will use a process of rapid infusion into a patient.
"We can infuse two units of blood in approximately two minutes," Smith said. "The device that we use to administer the blood is a life-flow rapid infuser. So this is going to connect to our whole blood and to our saline. And then the important thing is that after this blood has been stored between 2 degrees Celsius and 5 degrees Celsius, we need to warm it then to administer to the patient. So we also have a blood warmer."
The innovative partnership aligns the Sarasota County Fire Department and SunCoast Blood Centers with cutting-edge emergency medical practices, increasing survival rates in critical situations. Early whole blood transfusions have the potential to double the odds of surviving severe blood loss injuries, helping more patients.
Smith said the new process will dramatically change the emergency workers' jobs.
"It just enhances our ability to improve the patient outcomes," she said. "So whereas we've relied in the past to rapidly transport or potentially fly a patient via helicopter, we now have the ability to have almost a zero level response, and that we're able to get this going before the patient even begins transport. This is a game changer for Sarasota County."
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