By James Roach, DO, FACEP
Managing trauma patients with uncontrolled bleeding is a complicated challenge for healthcare providers, and trauma patients in hemorrhagic shock face high mortality rates.
Trauma is the leading cause of death for patients up to age 45, according to the American Association for the Surgery of Trauma, and among trauma patients, uncontrolled hemorrhage is the number one cause of preventable death. Broward Health continues to see an increase in trauma patients in our Emergency Departments.
At Broward Health, overall blunt injuries (such as motor vehicle crashes, motorcycle crashes, pedestrian accidents, falls, etc.) were up 13 percent in 2022 compared to 2021. Penetrating trauma injuries, such as shootings and stabbings, have also increased.
In the face of these challenges, Broward Health is working with our Emergency Medical Services (EMS) on an innovative program to improve outcomes for trauma patients. EMS teams have been trained and equipped to administer whole blood to trauma patients who are hemorrhaging – before they arrive at the hospital.
The Broward Sheriff’s Office Air Rescue was the first in the state of Florida to establish whole blood transfusion protocol.
Currently, most EMS teams around the nation use only isotonic IV fluids to treat hemorrhaging patients until arrival at the hospital for a blood transfusion. However, whole blood transfusion may be a better approach to treating hemorrhaging trauma patients.
Whole blood is natural blood that is unseparated, meaning that it contains all the components of blood (red blood cells, white blood cells, platelets and plasma).
This is different than a blood transfusion in a hospital, where a pint of donated blood is usually separated out into components. For example, a cancer patient may receive platelet transfusions, while an anemic patient might get red blood cells.
The U.S. Armed Forces have used whole blood transfusions for years to save lives in combat, but civilian use by EMS is new. Evidence in peer-reviewed medical journals suggests that whole blood may be a better option than IV fluids during pre-hospital trauma care, and that it can improve chances of survival.
Our EMS does an amazing job in the pre-hospital setting by getting to patients quickly, stabilizing them and bringing them to our ERs. One of our goals is to take their expertise and leverage that because EMS clinicians are a key part of our care team. For instance, EMS always plays a crucial role in treating patients with heart attacks or strokes where every minute counts.
However, historically, EMS has been limited in how they could help trauma patients. To exacerbate this situation, care may be inevitably delayed because rescue workers must first extricate a bleeding patient from a vehicle.
It is heartbreaking to hear a paramedic describe how demoralizing it is to watch a hemorrhaging patient deteriorate while waiting to be extricated after a car crash. In contrast, a paramedic recently shared a success story where they provided a life-saving transfusion to a patient who was bleeding internally while trapped in a vehicle. Currently, the EMS supplies the whole blood, but we are working on creating a system where the hospital could provide the blood in the future.
Our hope is that whole blood will empower EMS to provide the best possible care to trauma patients before they even arrive at the Emergency Department.
Dr. James Roach is Chief Medical Officer at Broward Health Medical Center and the District Chief of Emergency Medicine.
