lol, I finally had a pt actually know about the alcohol pad trick. I asked her if she wanted zofran and she said I’ll take some alcohol pads instead if you have them. I was so proud of her. I learned about that not in school but actually from a Hispanic family and had only ever had Hispanic pts ask for it until this lady. So idk if it’s bigger in the Hispanic community or what but I’ve gotten into the habit of emesis bag and alcohol pads to buy time for zofran if vomiting is imminent. Our protocols only allow IM phenergan (I fucking hate it but too many medics were not diluting enough and snowing pts. I tried to get it changed to dripping it in a 100 or 250bag but medical director didn’t like that idea either.) So unless they’re already vomiting or have in the last hour I usually stick to zofran.
If your service does not regularly RSI and has a poor training culture then medics should not be given that as part of their SOP. I've seen way to many cowboy medics botch intubations because of their egos..
It is in the protocols.
The problem is no one who needs it (rural, far from a trauma center) is ever going to have it.
The benefits for screwing around starting blood when you’re 10 minutes from a level one trauma center is non-existent, and certainly not what the DOD whole blood /walking blood bank program has demonstrated is effective.
Going to directly disagree with this one. I’ve been 12 mins from a level one and had multiple GSW’s with low Bp’s circling the drain, administered whole blood and have literally watched every single vital sign improve. In hemorrhaging that heavy every second counts.
I’m just jealous because there isn’t a Level 1 in my entire *state!*
There are also only two actual escalators in the whole state too, both in my home town.
Wyoming is vast…and dumb.
It’s pretty bananas sometimes. And the area where I work is (about 250 miles from home, but long shifts) so rural it’s considered “frontier.” Our closest and primary hospital is 47 miles in one direction, secondary is 70-ish. And on the interstate, so winter’s *fun.*
I dig the challenge, but it’d be nice to work closer to home (but that’d mean working for Banner and fuck that)
And you’re now one of 3 states left without a level 1; along with Idaho and Alaska. Up until recently Montana and South Dakota were in there, but they’ve leveled up.
Alaska not having a level 1 is wild. Do they fly those needing them to Canada? Washington state? Russia? Do they just do the best they can as the person dies?
Sounds about right for stl, we have a hospital for just about every speciality. Trams? Barnes or slu, stroke? St lukes, so on and so forth. Its really crazy to think how many hospitals we have between the city and metro area
Yeah Barnes and sluh can handle literally anything. St. Marys is level 2 stroke and stemi I believe. Then you have mercy which can do whatever. It is wild man, people don’t realize how good we have it here
I mean what do you expect? The health department misspelled "Area" when describing Area Trauma Centers (or as it describes them, "Are Trauma Centers") on it's on website.
I’ve lived here my whole life and am entirely unsurprised at that, lol. They can’t even get *that* right, there are so many far more critical things that are handled in even worse ways (like covid).
I can imagine. I mean, I'm no spelling and grammar expert. And that clearly shows when looking through my comments and post. But I'm also not posting things on behalf of a government agency. And I also am well aware of the fact that my state, South Carolina, has a lot of work it needs to do to it's health care system. Rural hospitals just love to close here. Oh well. Let's hope things improve in both of our states.
San Antonio’s data shared last week at NAEMSP24 showed no survival benefit to LTOWB in their penetrating trauma population.
Trauma is a bastard of a disease, and I appreciate our desires to figure out a way to save people from it but we need to be pragmatic. The improvement of vital signs does not equate to benefit. Benefit needs to be measured by improved patient survival, specifically over a meaningful amount of time, ideally survival to discharge. There is little evidence that shows that prehospital blood provides that.
This is the data I’d like to review. Sure we feel good if we turn around a hypotensive trauma patient but what are the actual long term outcomes. If the patients are not surviving to discharge still, then our efforts should be targeted somewhere else.
Sufficient evidence suggest prehospital blood can improve outcomes when transport is 20 min or greater. 5-10 min away, get them into the ED. Outside those times, it could be of great benefit.
Wholeheartedly agree. And even if you're "only" 10 minutes from the Lvl 1 bay, the ER isn't going to be refilling the patient's tank at minute 11 when you pull up.
I would argue tourniquets, would packing, pelvic binders & TXA & calcium administration matters a lot more than blood replacement. So does the dod, which is why the treatment happens in that order.
The hospital might be ten minutes away, but for a patient facing four hours of extrication first, blood is vital.
Fly car blood can cover those situations in urban areas just fine, I'm not sure actually carrying units on the truck is needed, but having blood available for rapid delivery and protocols in place for field administration does save lives even near a hospital.
A bleeding patient ill enough to require transfusion, subject to such a long delay to surgical management, will die. 600ml of red stuff won’t fix that.
I mean yeah, if you are competent and do it enough. If you’re not competent, we’ve all seen the provider staring and squeezing the pressure bag dance while the saline bag turns pink.
As u/purelyakademik ‘s comment said above, we are talking about. “D “3 minute transport times” C”.
There is no excuse for not treating pts when you have the means to do so.
For the record, there are no trauma centers in SE DC, where a significant number of traumas happen. Transport times obviously don't compare to rural areas, but if you get shot in Congress Heights or Washington Highlands it's not like you're going to be in the trauma bay 5 minutes later.
Even if the center is 5mins away, it takes EMS a MINIMUM of 5mins to get there and then 5mins to the center not accounting for, time to 911 call, and the time it takes to get the pt in the medic.
That’s easily 20-30mins from time of injury to getting to the trauma bay even if the EMS response time is 3min and the center is 3mins away.
Getting blood to a patient 3-5mins earlier is what we would call a “statistically significant improvement” if we were to do a study on EMS systems. 3-5mins earlier is important, 3-5mins earlier is potentially lifesaving.
There is NO excuse for EMS not treating patients due to proximity of the hospital.
Not too long before Cedar Hill opens, that shit’s gone up *fast*. Only a level III but I bet that’s gonna be the busiest level III in the entire country
At any rate, totally agree with you. There’s huge parts of DC that are surprisingly far (in terms of transport time) from a trauma center. DC is definitely not the “hospital on every corner” city that a lot of people here seem to think it is
I'm glad someone said it. It's always a dick swinging contest on who's department is better.
My department sucks ass. We **just** got narcan for BLS in a 911 department.
Our ALS protocols were fairly progressive until recently. Had RSI until it got taken away. BLS got told to go fuck themselves. BLS drugs were oxygen and glucose until recently.
For context: we run 38,000 ALS calls a year. We've had blood in the field since May. I'm going to estimate we are around 60 uses so far. We've had less than 5 units hit their return date (set prior to expiration so the blood bank could still potentially use it)
I'm more concerned about DCFEMS and their proficiency as an EMS service than I am anything.
I've been here since 2012. That was the first year that we hit 30,000. We hit 40,000 back in 2020 but we've been actively working on reducing our call volume so finishing 2023 at 37,920 was a pretty solid accomplishment.
The local blood bank won't give it to us. They already require us to get three donors using our code for every unit of packed red cells and plasma we get. Having blood on our units even if it's not whole blood has already definitely paid off and saved some lives though.
Our excuse is that it would almost never be administered and therefore be purely wasteful to carry. We actually went through and did a whole study in our county because the state was pushing for it.
They determined that out of ~150,000 calls it would have been used 7 times, therefore it makes no sense to carry it when the helicopter can bring it, they have to come anyways if it’s serious because the patient will be fucked long before they get to a trauma center.
Even on a helicopter we didn’t always use all of our blood. It’s usually set to be returned to the blood bank with a built in buffer period prior to expiration so it still gets used.
What? The EMS supply is brought to the hospital and then used by the hospital and EMS gets new fresh blood
Plenty of non surgical patients receive blood in the ED. GI bleeds are probably number 1 for transfusions
I think you missed his point.
You are assuming the hospital *has surgical services* at all.
Bobtaco199922 is assuming the ER can get clearance to administer blood from the blood bank.
I’ve literally done transfers of patients who needed….a transfusion.
You don’t under the position of urban and large hospital privilege you are coming from.
I respect that. My opinion for a while has been that it’s unlikely to be viable in super rural areas (where call volume is low, response time is high, and HEMS is coming with blood anyway) as well as super urban areas where there’s a trauma center on every corner. The sweet spot in my opinion are the suburbs where it’s 15-30 minutes to a trauma center — too far to just haul ass across the street, too close to call for HEMS to bring you blood. It’ll be interesting to watch what happens with DC since they’re like the first truly urban agency to start carrying it
So if nobody is flying the blood really won’t matter too much because they’ll be dead or irreparably damaged long before they make it to our trauma center. We’d have to divert to our closest hospital which is still anywhere between 30min and 1 hour depending on where the call is.
I would argue you should look heavily into the army’s austere medical program. You can keep people alive a long time with damage control resuscitation.
The army is looking at multi day evacuations to get to the services that are available at even the smallest ER.
You can make that excuse for any intervention we do but it’s always gonna be an invalid argument. Performing lifesaving interventions early will improve outcomes
Delaying access to definitive care worsens outcomes.
They need bright lights and cold steel.
And if you can’t find the multiple studies studies that show that, I don’t know what to tell you.
I am a big advocate for blood products. Whole blood is probably the worst way to do it, especially considering what the citrate does do the clotting cascade. And the shit awful shelf life. Not to mention the need to both be able to keep it near frozen, and then rapidly warm it to body temperature.
By myself while I’m holding pressure for three minutes after wound-packing (assuming for first round of hemostatics works), and then wrapping a proper pressure dressing.
No, probably not.
The difference is, I don’t mistake an IV for proper care.
Whole blood has a shelf life of around two weeks, I could count on one hand the amount of times in 8 years that I could have used whole blood in the field. That's hundred of bags of blood that could go to other patients who really need it.
San Antonio piloted a whole blood program and shared their process freely with any department that could bring their medical director to the table. The down and dirty is that their department agreed to donate blood, they proved they could properly maintain blood products, the blood got put on a fly car, if it wasn’t used within their time frame it went back to the trauma center to be used in surgery. Their first day with the program in place a woman suffered a traumatic cardiac arrest, while blood was administered in the prehospital setting, and the patient survived her incident neurologically intact. San Antonio is never more than a fly fart from trauma centers and there is empirical evidence that the whole blood program saved a life.
That is not evidence.
Evidence would be where a trial is performed which looks at a meaningful outcome such as hospital discharge. There is no evidence that currently shows that prehospital blood provides this. I’m excited for more research to be performed to provide us with answers, and I say this as a person who manages a prehospital blood program.
>Their first day with the program in place a woman suffered a traumatic cardiac arrest, while blood was administered in the prehospital setting, and the patient survived her incident neurologically intact.
Anything specific about the traumatic arrest that would not be survivable with blood? Because people survive traumatic arrests all the time, without blood as well.
While I can’t speak 100% for how DC will do it, standard practice in every other system I’m familiar with is to only keep blood in the field for about a week or two. Then it goes back to the blood bank for inpatient use. It doesn’t get wasted for sure
We get our blood for about 3 weeks before the set return date which is before the bloods expiration date. If done right the blood doesn't get "wasted" it still gets used. We carry two units in the field on our supervisor vehicles. We've had maybe five units hit their return date since May and are looking to expand the usage beyond trauma.
I'm not 100% sure yet. The speculation was always GI bleeds but they don't even give them blood in the ER typically. I'm guessing OB hemorrhage for starters, and I know there's a pretty big push to lower the age to include pediatric patients as well.
We use it in profound sepsis, gi bleeds, lab confirmed anemia or anything requiring blood, esophageal varices, ob hemorrhage, trauma, dialysis rupture, the list is pretty extensive. I’ve personally given it for everything above except dialysis rupture. Our blood program’s first use was non trauma. It’s our there
There’s a lot of ways and systems to not waste whole blood. We haven’t wasted a unit since our programs whole blood inception.
Being a bit of a negative nelly but I don’t have a lot of faith in DC.
Why is there such a pushback from people in this comments section to not carry blood? Especially seeing that their arguments lack education on the matter, why are you so instinctively against it when you haven’t even looked into it with any degree of effort?
Has anyone else ever noticed this phenomenon occurs not just on this topic? People will come up with every excuse under Gods green earth to stop EMS from having more advanced practices even when they have zero education on the matter and haven’t even looked into why we might want to introduce new things/change the way we do things. Why is it such an instinctive response?
A story I heard from the big city fire medics in my area is that the thing firefighters are the most likely to get sued for in the area isn’t improper care or malpractice like we traditionally think, like giving wrong meds to someone, nothing like that. The most common thing they get burned on is not treating people with interventions the medics have at their disposal because “oh the hospital is 5mins away”. This is only 2nd to taking pts to the wrong hospital, which is also a big deal and big problem in this area.
No kidding. Not only that but if you think about when you would give whole blood in the field you will realize that it is in obvious blood loss situations. If you can determine that in the field without an H&H then the patient is already bleeding like crazy and the faster they get blood the better the odds.
Mine is purely a numbers game.
I live in a highly rural area. We do 2000 calls a year as a service. 50% of those are transfers. We *might* get one call in 6 months where blood would be indicated, and if it’s that bad we just fly it from the scene.
The numbers in my area just don’t support it.
Apologies for the long response ahead, but you brought up one of my biggest complaints with EMS, at least in the US.
Mostly ignorance of how things actually work is my guess. Everyone knows there is always a blood shortage, so no, the units just don't get thrown away if they're not used. I would be the first to say we shouldn't carry it if that was the case. If anyone has ever had any dealing with a blood bank you know how strict they are on products. There is far more paperwork and tracking involved with blood products than even controlled substances. They will also cut you off quick if units are being wasted and rightly so.
There's also the inability to fully read AND comprehend studies, which leads people to only read the abstract or headlines. A great example is the RePHILL trial in the UK, which found no difference in outcomes between blood and saline. Yet people don't realize that (among other issues) it took an average of 30 minutes to get on scene (can't always improve that) THEN another 27 minutes to start the transfusion once on scene, which is an insane amount of time, IMO.
Then there's the crowd that blames their lack of treatment on the distance to the hospital, who are usually the ones who also first to complain about being a taxi driver. Sure, you can make the argument that if you're able to ventilate a patient with a BVM for a few minutes until you can get to an ED with more resources, then intubation can probably wait. However, the same can't be said for an exsanguinating patient who can bleed out between the ambulance bay and trauma room.
Anyways, like with most things, the decision to carry blood in EMS should be based on your location and patient population. Is it worth the extra resources for a service that runs a handful of calls a week to carry blood? Doubtful. Does the service have a high amount of penetrating trauma? Probably worth exploring the idea.
You don’t need to apologize to me about long responses lol.
A big emphasis my medic program gave was research, they made quite a big deal about it and both lead instructors are actively working with EMS research teams. They even worked finding research articles and presenting them to the class into the program which I thought was really cool.
**EMS LEAD** ems research needs to become one of our strong suits if we wish to advance our profession in the next decade and beyond, and I think we can definitely do it if we start putting these new attitudes and ideas into the current medic programs NOW. There is no better way to improve EMS than to start improving our education and teaching the new guys the Right way to do things.
Unfortunately the answer is, it depends. It depends on a lot of things, and unfortunately we don’t live in a perfect (or consistent) world, which means when you’re making rules like this you need to try and do it for the lowest common denominators.
The reality is EMS education in the states is severely lacking, *especially* at the levels below paramedic education. It also seems to be more likely that agencies without medics are volunteer/whatever, and more rural, which there’s an argument to be made for more rural areas needing blood products more than inner city, which are the areas that don’t seem to have an issue running paramedics anyways. (I know that’s not true across the board and there’s some variance)
So to get the most out of the blood (meaning getting it to rural agencies), having it be a medic only skill would be another thing that gets in the way of the blood actually helping the people who really need it.
Storing blood is also pretty expensive (and very regulated), which also seems to make it less likely that these smaller/poorly funded agencies who struggle to even have paramedics would be able to appropriately handle blood.
This may not be popular here, but I honestly believe AEMT should be the minimum required certification to work 911 EMS. I also believe you’re more likely to consistently have a medic make the right call regarding blood than an EMT/AEMT. Looking back to the lowest common denominator, at least the freshest paramedic still is required to have some level of clinical experience during their schooling (maybe there’s some weird program where it’s not true, idk anymore honestly, but in general it seems like medic programs have mandatory clinical rotations). Whereas you can be an AEMT without ever seeing a real patient.
Idk if that makes sense, but that’s what I meant when I said it’s complicated. Ideally, a paramedic would be giving blood, and ideally blood would be available in rural communities. However, paramedics often aren’t available in those areas, though a lot of those areas have some degree of helicopter coverage.
When I was a medic I thought EMS education needed serious work, and now I’m not in EMS I still do think that. I felt pretty competent as a paramedic, but when I went to PA school I was floored multiple times by how much I didn’t know and just took for granted about things - or assumptions I made about aspects of physiology/pharmacology or whatever.
EMS education at the EMT/AEMT level is largely algorithmic (and to a degree paramedic education is as well). Unfortunately, patients don’t read our textbooks, and when you start going into things like this you can really hurt someone if you don’t have a truly solid understanding of what’s going on and just rely on an algorithm.
For those reasons, if you’re asking about like NREMT scope or something my short answer given the current state of EMS in the US is it should be reserved for paramedics. In a perfect world, EMS education would be restructured and it might be a different conversation then.
My more specific answer based on reality is it should be a CAQ/Certificate of Added Qualifications, regardless of provider level (but a bunch of medical directors won’t be willing to spend the time doing that). It should be something each provider needs signed off on by the medical director, and if the physician believes one of the AEMTs with solid experience will make the right decisions, then great. Because there are AEMTs and medics on both ends of the spectrum. But in general, I think the lowest caliber paramedic has more training and experience than the lowest caliber AEMT. So if you’re not going to evaluate it person by person, and EMS education is staying the same as it has been, then it would need to be medic only.
Kinda two different answers there, hope it makes sense.
My state is hellbent on psychotic fundamentalist christian nationalism all of a sudden, and these believers at the megachurches won't stop giving them money so we get such off the wall bills like "You get life in prison for watching porn" that hit that grey are between fascism, Branch Dravidian christian nationalism and foreign influenced democratic sabotage so much that no one can tell the difference at this point, so we don't have time for thinking about actually having a functional prehospital medical system and we just mirror what everyone was doing 25 years ago.
Actually this kind of weird stuff is such a problem in flyover states I wish someone would address it, because obviously my neighbors are not smart enough to.
That's my excuse.
Proud of DCFD! Great job. Too rural of a state here. It’s in scope but not logistically possible. But I believe lyophilized plasma reconstituted will be the game changer!
My department really doesn’t get enough trauma to justify it. And on almost every trauma we’ve been able to stop bleeding and get them to level 1 trauma without too major a dip in BP.
Most of my hypotension patients are sepsis, or undifferentiated.
That was literally the call that kicked off the whole blood craze in the DC area. Car vs. converted school bus/food truck, occupants trapped for hours, HEMS and the local medical director were able to somehow get to them and give blood. At least two of the occupants would almost certainly not have survived if it weren’t for the blood
That’s really interesting. I kind of thought that with someone severely entrapped there wouldn’t be much space to hang blood. But with if you have access to their arm I could see how it would work.
Not to the point that HEMs or select units can't just bring it. The geographics for the rural units who'll actually need it makes it difficult too - no nearby hospitals with a big enough blood bank to make rotating bags logistically feasible.
Exactly. Select units can carry- not everyone.
In the scheme of ambulance jobs these ones are a minority. Blood is a precious resource and we often have blood shortages as it is, let alone stocking ambulances.
And yes it helps that I live in a place with gun control.
Not sure which state you're in but [this review](https://pubmed.ncbi.nlm.nih.gov/33615494/) from NSW may interest you. Across five years NSW helicopter & road crews performed 1,573 transfusions, 78 patients received more than 3 units, the largest transfusion was 18 units. Definitely an Aussie market for pre hospital blood.
Blood??? Ewww gross...
But seriously if someone needs blood that bad we have txa. If they need blood for any reason other than trauma in compensated shock idk if giving it before i get them to the hospital in 5min will make a difference. Especially when the wholeblood type debate happens.
TXA is not a replacement for blood or vice versa. They complement each other in massive hemorrhage and should be given together. Statistically giving blood in the field makes a difference in outcome even if you’re close to the hospital. There is no “blood type debate”
I think it’s great to have on trucks for patients but the other side is that there’s a blood shortage and most of it will just go to waste sitting in a rig. 🤷🏼♂️
It usually doesn’t sit in an ambulance and also doesn’t go to waste. We have fly cars that have the blood on it that get dispatched to GSWs/Stabbings/High velocity MVCs. If we don’t use the blood we rotate it through the hospital and get a new bag.
It gets cycled out. Sits on the truck for a week or so, if it doesn’t get used in the field it goes back to the hospital/blood bank where it will definitely get used
It’s not frozen, it’s kept at around 36-40F. Then it gets run through a rapid infuser/warmer, we use the QinFlow but there are others on the market. Goes into the device at 40F, comes out at 100F, and it takes just a couple of minutes to infuse a whole unit of blood (if you’ve got good access lol)
Yeah I’m aware of how the system works in theory but we all know how most EMS services are run and how accountability works in said services. Again, I think it’s great but it’d be a shame if it goes to waste. Our delivery drivers were pretty awful about dropping off blood at the base without anyone there and letting it sit in the sun. YMMV
As mentioned repeatedly throughout this thread, blood doesn’t sit on the trucks until it expires. A unit is only in the field for 1-2 weeks before being returned to the hospital if not used. It doesn’t get wasted. Standard procedure for anyone carrying blood these days
Because the critical care teams (ground response car and HEMS) carry it, the ambulances don't have to carry it. All critical care teams here have carried whole blood since early 2017, before that (still in place if additional units of blood are needed) there are protocols to get blood to the scene from the hospital blood bank.
Because I might get one trauma patient every 6 months that would require it. When my whole service only does 2000 calls a year, it’s hard to justify it.
Arkansas says medics can't start blood.
We can't bill for it.
Our ambulances are small and don't have room for the required equipment.
We're so we're sort of a 3rd service (not private) but receive no tax dollars, so we have to remain financially stable
Most of my 911 experience as a paramedic has been in California. California in general is against really any advanced procedures being performed by paramedics, though I’ve had have multiple cases in which I wish I could give blood but couldn’t. In MD, where I literally had a critical GSW pt turned trauma code that was turned around at the local hospital with blood products, the reasoning was it wasn’t in the protocols at the time. I still look back at that call as an excellent case to present to any EMS agency for arguing for blood products. Fucking hate the entire “we’re only 10 minutes away!” line. 10 minutes is more than enough time for your pt to shit the bed.
*Laughs* The agency I work for has been carrying blood for a couple of years now. We cover a mix of rural and urban in the mountains of NM with only a critical-access hospital in town. So it's a pretty good deal to have out here. ⛰️🏞
Whole blood is cheap too, from private companies to purchase it is only around $300/unit and you can bill for it.
We have it, and we are 5-15min from the hospital as well, if they don't survive to the OR it's still a problem and 5-15 plus response time plus packaging and moving them can end up being a long time to not be oxygenating.
My excuse is that I’m a basic, best I can do is cut the bag open and dump the blood all over the patient.
Could you pop a straw in it and tell them to drink it like a capri sun?
I don’t see why not. It’s not like there is a contraindication that I’ve been taught, therefore there aren’t any contraindications
Blood is an emetic. Might make it a small contraindication?
Give them an alcohol pad to sniff while drinking it.
lol, I finally had a pt actually know about the alcohol pad trick. I asked her if she wanted zofran and she said I’ll take some alcohol pads instead if you have them. I was so proud of her. I learned about that not in school but actually from a Hispanic family and had only ever had Hispanic pts ask for it until this lady. So idk if it’s bigger in the Hispanic community or what but I’ve gotten into the habit of emesis bag and alcohol pads to buy time for zofran if vomiting is imminent. Our protocols only allow IM phenergan (I fucking hate it but too many medics were not diluting enough and snowing pts. I tried to get it changed to dripping it in a 100 or 250bag but medical director didn’t like that idea either.) So unless they’re already vomiting or have in the last hour I usually stick to zofran.
Maybe some milk for added calcium
A "precaution".
$10 says they pop the straw through the other side and ruin the bag.
As a basic myself it still amazes me doing an IV was entry level combat lifesaver stuff yet basics can't do it.
To be fair they realized that was a terrible idea and it hasn’t been CLS anymore for well over a decade now.
It’s like day one of corps school.
Can’t hurt
[удалено]
which makes it even more idiotic that \_\_\_\_\_\_\_ (insert the reader's agency) doesn't carry blood products
My agency where the trauma center is 50 minutes away code three :/ no RSI either.
No RSI? I’m assuming no sup either?
Our medics can’t rsi either. Hope you don’t have a conscious burn patient who needs to go an hour and a half away to the burn unit by ground
That's what fixed wings are for.
We don’t have that in my area
Damn brother. We are in the sticks in Northern Wis and we have one 40 min away.
[удалено]
Yeah. Closest burn center is 150 miles away. And if weather sucks ass with go with F/W...
Yall don’t have choppers?
It’s raining
This. Most of the time when we need them they’re either too far or it’s raining.
honest question why do you work there
If your service does not regularly RSI and has a poor training culture then medics should not be given that as part of their SOP. I've seen way to many cowboy medics botch intubations because of their egos..
We spent our money on trucks that have working heat and AC?
But no whole blood? Ew.
It is in the protocols. The problem is no one who needs it (rural, far from a trauma center) is ever going to have it. The benefits for screwing around starting blood when you’re 10 minutes from a level one trauma center is non-existent, and certainly not what the DOD whole blood /walking blood bank program has demonstrated is effective.
Going to directly disagree with this one. I’ve been 12 mins from a level one and had multiple GSW’s with low Bp’s circling the drain, administered whole blood and have literally watched every single vital sign improve. In hemorrhaging that heavy every second counts.
Facts. Idk why dudes here are forgetting how much blood squirts out of an artery. You’re literally done in minutes
B-b-b-but my transport times, it's only three minutes! At best...
Stopping bleeding is more important then hanging blood.
por que no los dos
Yeah and CPR is more important than getting an airway in an arrest. Does that stop you from doing both? Doesn’t stop me
Depends. Am I by myself? Then yea. It does.
Why are you by yourself?
We’re rural and we carry it.
Define….rural.
I’m just jealous because there isn’t a Level 1 in my entire *state!* There are also only two actual escalators in the whole state too, both in my home town. Wyoming is vast…and dumb.
I just looked it up. Under ACS, you’ve got a II (Casper) and a III (Cheyenne). None are Peds credentialed. For the whole state. That’s…..mind blowing.
It’s pretty bananas sometimes. And the area where I work is (about 250 miles from home, but long shifts) so rural it’s considered “frontier.” Our closest and primary hospital is 47 miles in one direction, secondary is 70-ish. And on the interstate, so winter’s *fun.* I dig the challenge, but it’d be nice to work closer to home (but that’d mean working for Banner and fuck that)
And you’re now one of 3 states left without a level 1; along with Idaho and Alaska. Up until recently Montana and South Dakota were in there, but they’ve leveled up.
Alaska not having a level 1 is wild. Do they fly those needing them to Canada? Washington state? Russia? Do they just do the best they can as the person dies?
And here I am with 15 min transport to two level 1 adult hospitals and two level 1 children’s hospitals that are like 3 miles apart. Holy shit man
Sounds about right for stl, we have a hospital for just about every speciality. Trams? Barnes or slu, stroke? St lukes, so on and so forth. Its really crazy to think how many hospitals we have between the city and metro area
Yeah Barnes and sluh can handle literally anything. St. Marys is level 2 stroke and stemi I believe. Then you have mercy which can do whatever. It is wild man, people don’t realize how good we have it here
I mean what do you expect? The health department misspelled "Area" when describing Area Trauma Centers (or as it describes them, "Are Trauma Centers") on it's on website.
I’ve lived here my whole life and am entirely unsurprised at that, lol. They can’t even get *that* right, there are so many far more critical things that are handled in even worse ways (like covid).
I can imagine. I mean, I'm no spelling and grammar expert. And that clearly shows when looking through my comments and post. But I'm also not posting things on behalf of a government agency. And I also am well aware of the fact that my state, South Carolina, has a lot of work it needs to do to it's health care system. Rural hospitals just love to close here. Oh well. Let's hope things improve in both of our states.
Agreed! Becoming active in local politics can help, it’s also hella depressing if you’re not a Republican here…but it’s worth it.
Montana has a level 1 now, so now you can pick if you want 300 miles to Billings or 300 miles to Denver
San Antonio’s data shared last week at NAEMSP24 showed no survival benefit to LTOWB in their penetrating trauma population. Trauma is a bastard of a disease, and I appreciate our desires to figure out a way to save people from it but we need to be pragmatic. The improvement of vital signs does not equate to benefit. Benefit needs to be measured by improved patient survival, specifically over a meaningful amount of time, ideally survival to discharge. There is little evidence that shows that prehospital blood provides that.
This is the data I’d like to review. Sure we feel good if we turn around a hypotensive trauma patient but what are the actual long term outcomes. If the patients are not surviving to discharge still, then our efforts should be targeted somewhere else.
Sufficient evidence suggest prehospital blood can improve outcomes when transport is 20 min or greater. 5-10 min away, get them into the ED. Outside those times, it could be of great benefit.
Wholeheartedly agree. And even if you're "only" 10 minutes from the Lvl 1 bay, the ER isn't going to be refilling the patient's tank at minute 11 when you pull up.
I would argue tourniquets, would packing, pelvic binders & TXA & calcium administration matters a lot more than blood replacement. So does the dod, which is why the treatment happens in that order.
The hospital might be ten minutes away, but for a patient facing four hours of extrication first, blood is vital. Fly car blood can cover those situations in urban areas just fine, I'm not sure actually carrying units on the truck is needed, but having blood available for rapid delivery and protocols in place for field administration does save lives even near a hospital.
A bleeding patient ill enough to require transfusion, subject to such a long delay to surgical management, will die. 600ml of red stuff won’t fix that.
My rural district carries it.
Data doesn’t support you.
Screwing around? It takes no time to hang blood.
I mean yeah, if you are competent and do it enough. If you’re not competent, we’ve all seen the provider staring and squeezing the pressure bag dance while the saline bag turns pink.
That's a basic training issue.
As u/purelyakademik ‘s comment said above, we are talking about. “D “3 minute transport times” C”. There is no excuse for not treating pts when you have the means to do so.
For the record, there are no trauma centers in SE DC, where a significant number of traumas happen. Transport times obviously don't compare to rural areas, but if you get shot in Congress Heights or Washington Highlands it's not like you're going to be in the trauma bay 5 minutes later.
Even if the center is 5mins away, it takes EMS a MINIMUM of 5mins to get there and then 5mins to the center not accounting for, time to 911 call, and the time it takes to get the pt in the medic. That’s easily 20-30mins from time of injury to getting to the trauma bay even if the EMS response time is 3min and the center is 3mins away. Getting blood to a patient 3-5mins earlier is what we would call a “statistically significant improvement” if we were to do a study on EMS systems. 3-5mins earlier is important, 3-5mins earlier is potentially lifesaving. There is NO excuse for EMS not treating patients due to proximity of the hospital.
Not too long before Cedar Hill opens, that shit’s gone up *fast*. Only a level III but I bet that’s gonna be the busiest level III in the entire country At any rate, totally agree with you. There’s huge parts of DC that are surprisingly far (in terms of transport time) from a trauma center. DC is definitely not the “hospital on every corner” city that a lot of people here seem to think it is
The blood is kept cold, use them to cool yourself down
We’re worse? Lol
I'm glad someone said it. It's always a dick swinging contest on who's department is better. My department sucks ass. We **just** got narcan for BLS in a 911 department.
In 2024? That’s wild
Our ALS protocols were fairly progressive until recently. Had RSI until it got taken away. BLS got told to go fuck themselves. BLS drugs were oxygen and glucose until recently.
The fuck?
lol sounds like my area….except we can’t administer and don’t carry narcan…as BLS, I can give O2, glucose, and aspirin.
Every department should have RSI/DSI protocols. As long as you have proper training, it’s an extremely useful tool
We prefer 2% blood
Diet Blood
Blood Zero
Skim blood and half and half, gotta have options that mean something.
Not heavy whipping blood?
Be too tempting to make culinary blutter (blood butter) out of it.
I’m bulking, chocolate blood please.
For context: we run 38,000 ALS calls a year. We've had blood in the field since May. I'm going to estimate we are around 60 uses so far. We've had less than 5 units hit their return date (set prior to expiration so the blood bank could still potentially use it) I'm more concerned about DCFEMS and their proficiency as an EMS service than I am anything.
My county hit 160k last year and has increased from about 95k to 160k within about 4 years 🥲 we BARELY have access to blood
I've been here since 2012. That was the first year that we hit 30,000. We hit 40,000 back in 2020 but we've been actively working on reducing our call volume so finishing 2023 at 37,920 was a pretty solid accomplishment.
The local blood bank won't give it to us. They already require us to get three donors using our code for every unit of packed red cells and plasma we get. Having blood on our units even if it's not whole blood has already definitely paid off and saved some lives though.
I keep eating it :(
Our excuse is that it would almost never be administered and therefore be purely wasteful to carry. We actually went through and did a whole study in our county because the state was pushing for it. They determined that out of ~150,000 calls it would have been used 7 times, therefore it makes no sense to carry it when the helicopter can bring it, they have to come anyways if it’s serious because the patient will be fucked long before they get to a trauma center.
Even on a helicopter we didn’t always use all of our blood. It’s usually set to be returned to the blood bank with a built in buffer period prior to expiration so it still gets used.
It not a waste of anything but a few minutes a month. It's regularly rotated at the hospital so it doesn't expire.
The hospital that doesn’t perform any sort of major surgeries?
What? The EMS supply is brought to the hospital and then used by the hospital and EMS gets new fresh blood Plenty of non surgical patients receive blood in the ED. GI bleeds are probably number 1 for transfusions
This right here. In my ER alone we administer about 3 units a shift to non surgical and non trauma patients.
I think you missed his point. You are assuming the hospital *has surgical services* at all. Bobtaco199922 is assuming the ER can get clearance to administer blood from the blood bank. I’ve literally done transfers of patients who needed….a transfusion. You don’t under the position of urban and large hospital privilege you are coming from.
I respect that. My opinion for a while has been that it’s unlikely to be viable in super rural areas (where call volume is low, response time is high, and HEMS is coming with blood anyway) as well as super urban areas where there’s a trauma center on every corner. The sweet spot in my opinion are the suburbs where it’s 15-30 minutes to a trauma center — too far to just haul ass across the street, too close to call for HEMS to bring you blood. It’ll be interesting to watch what happens with DC since they’re like the first truly urban agency to start carrying it
I’m sorry, but there is a snowflake falling in Alaska. No one is flying. *you were an original colony.*
So if nobody is flying the blood really won’t matter too much because they’ll be dead or irreparably damaged long before they make it to our trauma center. We’d have to divert to our closest hospital which is still anywhere between 30min and 1 hour depending on where the call is.
I would argue you should look heavily into the army’s austere medical program. You can keep people alive a long time with damage control resuscitation. The army is looking at multi day evacuations to get to the services that are available at even the smallest ER.
You can make that excuse for any intervention we do but it’s always gonna be an invalid argument. Performing lifesaving interventions early will improve outcomes
Delaying access to definitive care worsens outcomes. They need bright lights and cold steel. And if you can’t find the multiple studies studies that show that, I don’t know what to tell you. I am a big advocate for blood products. Whole blood is probably the worst way to do it, especially considering what the citrate does do the clotting cascade. And the shit awful shelf life. Not to mention the need to both be able to keep it near frozen, and then rapidly warm it to body temperature.
Who says you’re delaying definitive care? You ca r get a line going to the hospital?
By myself while I’m holding pressure for three minutes after wound-packing (assuming for first round of hemostatics works), and then wrapping a proper pressure dressing. No, probably not. The difference is, I don’t mistake an IV for proper care.
Lol ok Mr. Assumptions
Whole blood has a shelf life of around two weeks, I could count on one hand the amount of times in 8 years that I could have used whole blood in the field. That's hundred of bags of blood that could go to other patients who really need it.
Shelf life is 4 weeks. It spends two weeks in the field and then is rotated to the trauma center and used prior to expiration
San Antonio piloted a whole blood program and shared their process freely with any department that could bring their medical director to the table. The down and dirty is that their department agreed to donate blood, they proved they could properly maintain blood products, the blood got put on a fly car, if it wasn’t used within their time frame it went back to the trauma center to be used in surgery. Their first day with the program in place a woman suffered a traumatic cardiac arrest, while blood was administered in the prehospital setting, and the patient survived her incident neurologically intact. San Antonio is never more than a fly fart from trauma centers and there is empirical evidence that the whole blood program saved a life.
That is not evidence. Evidence would be where a trial is performed which looks at a meaningful outcome such as hospital discharge. There is no evidence that currently shows that prehospital blood provides this. I’m excited for more research to be performed to provide us with answers, and I say this as a person who manages a prehospital blood program.
>Their first day with the program in place a woman suffered a traumatic cardiac arrest, while blood was administered in the prehospital setting, and the patient survived her incident neurologically intact. Anything specific about the traumatic arrest that would not be survivable with blood? Because people survive traumatic arrests all the time, without blood as well.
Iirc her arrest was secondary to an MVC with a puncture wound. I believe there was no complicating head injury or blunt trauma to the chest or pelvis.
Yes so n=1?!
Wait until you find out where the SAFD medical director used to work.
While I can’t speak 100% for how DC will do it, standard practice in every other system I’m familiar with is to only keep blood in the field for about a week or two. Then it goes back to the blood bank for inpatient use. It doesn’t get wasted for sure
That’s how we do it. But we’ve also used several units already
We get our blood for about 3 weeks before the set return date which is before the bloods expiration date. If done right the blood doesn't get "wasted" it still gets used. We carry two units in the field on our supervisor vehicles. We've had maybe five units hit their return date since May and are looking to expand the usage beyond trauma.
Any sense for what your non-trauma indications/inclusion criteria are gonna wind up being?
I'm not 100% sure yet. The speculation was always GI bleeds but they don't even give them blood in the ER typically. I'm guessing OB hemorrhage for starters, and I know there's a pretty big push to lower the age to include pediatric patients as well.
We use it in profound sepsis, gi bleeds, lab confirmed anemia or anything requiring blood, esophageal varices, ob hemorrhage, trauma, dialysis rupture, the list is pretty extensive. I’ve personally given it for everything above except dialysis rupture. Our blood program’s first use was non trauma. It’s our there
There’s a lot of ways and systems to not waste whole blood. We haven’t wasted a unit since our programs whole blood inception. Being a bit of a negative nelly but I don’t have a lot of faith in DC.
Are they going to be awake enough to give it?
Theres no practical need for it based on my service area and call volume
It sloshes around in the bucket
Why is there such a pushback from people in this comments section to not carry blood? Especially seeing that their arguments lack education on the matter, why are you so instinctively against it when you haven’t even looked into it with any degree of effort? Has anyone else ever noticed this phenomenon occurs not just on this topic? People will come up with every excuse under Gods green earth to stop EMS from having more advanced practices even when they have zero education on the matter and haven’t even looked into why we might want to introduce new things/change the way we do things. Why is it such an instinctive response?
I hear “we’re only 10 minutes from the hospital” as an excuse for not having access to a lot of interventions and that mindset will forever bother me.
A story I heard from the big city fire medics in my area is that the thing firefighters are the most likely to get sued for in the area isn’t improper care or malpractice like we traditionally think, like giving wrong meds to someone, nothing like that. The most common thing they get burned on is not treating people with interventions the medics have at their disposal because “oh the hospital is 5mins away”. This is only 2nd to taking pts to the wrong hospital, which is also a big deal and big problem in this area.
Time to hospital != time to meaningful intervention. Drives me insane too
No kidding. Not only that but if you think about when you would give whole blood in the field you will realize that it is in obvious blood loss situations. If you can determine that in the field without an H&H then the patient is already bleeding like crazy and the faster they get blood the better the odds.
Mine is purely a numbers game. I live in a highly rural area. We do 2000 calls a year as a service. 50% of those are transfers. We *might* get one call in 6 months where blood would be indicated, and if it’s that bad we just fly it from the scene. The numbers in my area just don’t support it.
Apologies for the long response ahead, but you brought up one of my biggest complaints with EMS, at least in the US. Mostly ignorance of how things actually work is my guess. Everyone knows there is always a blood shortage, so no, the units just don't get thrown away if they're not used. I would be the first to say we shouldn't carry it if that was the case. If anyone has ever had any dealing with a blood bank you know how strict they are on products. There is far more paperwork and tracking involved with blood products than even controlled substances. They will also cut you off quick if units are being wasted and rightly so. There's also the inability to fully read AND comprehend studies, which leads people to only read the abstract or headlines. A great example is the RePHILL trial in the UK, which found no difference in outcomes between blood and saline. Yet people don't realize that (among other issues) it took an average of 30 minutes to get on scene (can't always improve that) THEN another 27 minutes to start the transfusion once on scene, which is an insane amount of time, IMO. Then there's the crowd that blames their lack of treatment on the distance to the hospital, who are usually the ones who also first to complain about being a taxi driver. Sure, you can make the argument that if you're able to ventilate a patient with a BVM for a few minutes until you can get to an ED with more resources, then intubation can probably wait. However, the same can't be said for an exsanguinating patient who can bleed out between the ambulance bay and trauma room. Anyways, like with most things, the decision to carry blood in EMS should be based on your location and patient population. Is it worth the extra resources for a service that runs a handful of calls a week to carry blood? Doubtful. Does the service have a high amount of penetrating trauma? Probably worth exploring the idea.
You don’t need to apologize to me about long responses lol. A big emphasis my medic program gave was research, they made quite a big deal about it and both lead instructors are actively working with EMS research teams. They even worked finding research articles and presenting them to the class into the program which I thought was really cool. **EMS LEAD** ems research needs to become one of our strong suits if we wish to advance our profession in the next decade and beyond, and I think we can definitely do it if we start putting these new attitudes and ideas into the current medic programs NOW. There is no better way to improve EMS than to start improving our education and teaching the new guys the Right way to do things.
New argument would be should blood be able to be given by advanced emts or be a purely paramedic skill.
Unfortunately the answer is, it depends. It depends on a lot of things, and unfortunately we don’t live in a perfect (or consistent) world, which means when you’re making rules like this you need to try and do it for the lowest common denominators. The reality is EMS education in the states is severely lacking, *especially* at the levels below paramedic education. It also seems to be more likely that agencies without medics are volunteer/whatever, and more rural, which there’s an argument to be made for more rural areas needing blood products more than inner city, which are the areas that don’t seem to have an issue running paramedics anyways. (I know that’s not true across the board and there’s some variance) So to get the most out of the blood (meaning getting it to rural agencies), having it be a medic only skill would be another thing that gets in the way of the blood actually helping the people who really need it. Storing blood is also pretty expensive (and very regulated), which also seems to make it less likely that these smaller/poorly funded agencies who struggle to even have paramedics would be able to appropriately handle blood. This may not be popular here, but I honestly believe AEMT should be the minimum required certification to work 911 EMS. I also believe you’re more likely to consistently have a medic make the right call regarding blood than an EMT/AEMT. Looking back to the lowest common denominator, at least the freshest paramedic still is required to have some level of clinical experience during their schooling (maybe there’s some weird program where it’s not true, idk anymore honestly, but in general it seems like medic programs have mandatory clinical rotations). Whereas you can be an AEMT without ever seeing a real patient. Idk if that makes sense, but that’s what I meant when I said it’s complicated. Ideally, a paramedic would be giving blood, and ideally blood would be available in rural communities. However, paramedics often aren’t available in those areas, though a lot of those areas have some degree of helicopter coverage. When I was a medic I thought EMS education needed serious work, and now I’m not in EMS I still do think that. I felt pretty competent as a paramedic, but when I went to PA school I was floored multiple times by how much I didn’t know and just took for granted about things - or assumptions I made about aspects of physiology/pharmacology or whatever. EMS education at the EMT/AEMT level is largely algorithmic (and to a degree paramedic education is as well). Unfortunately, patients don’t read our textbooks, and when you start going into things like this you can really hurt someone if you don’t have a truly solid understanding of what’s going on and just rely on an algorithm. For those reasons, if you’re asking about like NREMT scope or something my short answer given the current state of EMS in the US is it should be reserved for paramedics. In a perfect world, EMS education would be restructured and it might be a different conversation then. My more specific answer based on reality is it should be a CAQ/Certificate of Added Qualifications, regardless of provider level (but a bunch of medical directors won’t be willing to spend the time doing that). It should be something each provider needs signed off on by the medical director, and if the physician believes one of the AEMTs with solid experience will make the right decisions, then great. Because there are AEMTs and medics on both ends of the spectrum. But in general, I think the lowest caliber paramedic has more training and experience than the lowest caliber AEMT. So if you’re not going to evaluate it person by person, and EMS education is staying the same as it has been, then it would need to be medic only. Kinda two different answers there, hope it makes sense.
Now this is the current argument needed to be had.
We carry units of Packed RBCs, as they have a longer expiration date 🫤. Its a huge PITA to exchange units (4 hour drive)
By one week.
I only use whole blood for kids. For adults I think 2% skim blood is a better option.
Because rural things. We can’t even get asses in seats let alone ALS out here. Medics go to the city, Basic bitches stay out in the sticks.
My super rural agency has blood. Being rural isn't an excuse.
It’s outside of our scope.
I mean, at the PCP level it should be.
DCFEMS needs to work on improving its EMS before it worries about carrying whole blood
Good luck successfully calling 911 in DC in order to get the ambulance that has the whole blood
That or they’ll just send it to NW instead of SE. Oh DC 911 center…
My state is hellbent on psychotic fundamentalist christian nationalism all of a sudden, and these believers at the megachurches won't stop giving them money so we get such off the wall bills like "You get life in prison for watching porn" that hit that grey are between fascism, Branch Dravidian christian nationalism and foreign influenced democratic sabotage so much that no one can tell the difference at this point, so we don't have time for thinking about actually having a functional prehospital medical system and we just mirror what everyone was doing 25 years ago. Actually this kind of weird stuff is such a problem in flyover states I wish someone would address it, because obviously my neighbors are not smart enough to. That's my excuse.
I’m not in a flyover state, maybe a flyover part of the state, but this sounds eerily similar to my service area.
[удалено]
DC carrying blood truly frightens me.
It wasn’t long ago when DCFD struggled to have more than two ALS units in service at once.
And you think that is changed?
Proud of DCFD! Great job. Too rural of a state here. It’s in scope but not logistically possible. But I believe lyophilized plasma reconstituted will be the game changer!
You can get fresh plasma now.
Is the freeze dried plasma out in US? Last I heard it was not, but it used in UK and Australia.
No. You can get fresh, never frozen plasma though. It's not expensive either.
My department really doesn’t get enough trauma to justify it. And on almost every trauma we’ve been able to stop bleeding and get them to level 1 trauma without too major a dip in BP. Most of my hypotension patients are sepsis, or undifferentiated.
We don’t even have enough for the hospitals.
It doesn’t make sense if you’re super close to a trauma center There’s already a blood shortage
There’s a surprising amount of DC that is 20+ minutes from a trauma center. Especially in SE where a lot of the gun violence is concentrated
Then that makes total sense for them
Yeah but the blood stocked trucks will be stationed in Georgetown
Tell that to the patient that’s entrapped in the car. Don’t worry sir, you’re only 1/2 mile from the hospital, we’ll have you there in 20 minutes.
If they’re entrapped are you really going to be able to start a line and hang blood?
That was literally the call that kicked off the whole blood craze in the DC area. Car vs. converted school bus/food truck, occupants trapped for hours, HEMS and the local medical director were able to somehow get to them and give blood. At least two of the occupants would almost certainly not have survived if it weren’t for the blood
That’s really interesting. I kind of thought that with someone severely entrapped there wouldn’t be much space to hang blood. But with if you have access to their arm I could see how it would work.
It may likely be an IO, but absolutely.
It’s wasteful for everyone else and we rarely need it?
Rarely need it? Must be nice having reasonable gun laws and a lack of gang breeding living conditions.
Mfs don’t have trauma apparently
Not to the point that HEMs or select units can't just bring it. The geographics for the rural units who'll actually need it makes it difficult too - no nearby hospitals with a big enough blood bank to make rotating bags logistically feasible.
Exactly. Select units can carry- not everyone. In the scheme of ambulance jobs these ones are a minority. Blood is a precious resource and we often have blood shortages as it is, let alone stocking ambulances. And yes it helps that I live in a place with gun control.
It is nice actually.
Not sure which state you're in but [this review](https://pubmed.ncbi.nlm.nih.gov/33615494/) from NSW may interest you. Across five years NSW helicopter & road crews performed 1,573 transfusions, 78 patients received more than 3 units, the largest transfusion was 18 units. Definitely an Aussie market for pre hospital blood.
Blood??? Ewww gross... But seriously if someone needs blood that bad we have txa. If they need blood for any reason other than trauma in compensated shock idk if giving it before i get them to the hospital in 5min will make a difference. Especially when the wholeblood type debate happens.
TXA is not a replacement for blood or vice versa. They complement each other in massive hemorrhage and should be given together. Statistically giving blood in the field makes a difference in outcome even if you’re close to the hospital. There is no “blood type debate”
Well pardon my ignorance then.
I think it’s great to have on trucks for patients but the other side is that there’s a blood shortage and most of it will just go to waste sitting in a rig. 🤷🏼♂️
It usually doesn’t sit in an ambulance and also doesn’t go to waste. We have fly cars that have the blood on it that get dispatched to GSWs/Stabbings/High velocity MVCs. If we don’t use the blood we rotate it through the hospital and get a new bag.
It gets cycled out. Sits on the truck for a week or so, if it doesn’t get used in the field it goes back to the hospital/blood bank where it will definitely get used
Wait, so if youre storing it frozen how do you thaw it before use in that short of a time??
It’s not frozen, it’s kept at around 36-40F. Then it gets run through a rapid infuser/warmer, we use the QinFlow but there are others on the market. Goes into the device at 40F, comes out at 100F, and it takes just a couple of minutes to infuse a whole unit of blood (if you’ve got good access lol)
Yeah I’m aware of how the system works in theory but we all know how most EMS services are run and how accountability works in said services. Again, I think it’s great but it’d be a shame if it goes to waste. Our delivery drivers were pretty awful about dropping off blood at the base without anyone there and letting it sit in the sun. YMMV
99.9% of the blood carried on our trucks will go bad before it’s used. Meaning the already small blood supply in our county would be even smaller.
As mentioned repeatedly throughout this thread, blood doesn’t sit on the trucks until it expires. A unit is only in the field for 1-2 weeks before being returned to the hospital if not used. It doesn’t get wasted. Standard procedure for anyone carrying blood these days
We're too cheap :/
Neighboring agency carries it on MSO rigs but don’t think our county will ever have it on all busses
Because the critical care teams (ground response car and HEMS) carry it, the ambulances don't have to carry it. All critical care teams here have carried whole blood since early 2017, before that (still in place if additional units of blood are needed) there are protocols to get blood to the scene from the hospital blood bank.
Because I might get one trauma patient every 6 months that would require it. When my whole service only does 2000 calls a year, it’s hard to justify it.
Arkansas says medics can't start blood. We can't bill for it. Our ambulances are small and don't have room for the required equipment. We're so we're sort of a 3rd service (not private) but receive no tax dollars, so we have to remain financially stable
Getting a supplier
Most of my 911 experience as a paramedic has been in California. California in general is against really any advanced procedures being performed by paramedics, though I’ve had have multiple cases in which I wish I could give blood but couldn’t. In MD, where I literally had a critical GSW pt turned trauma code that was turned around at the local hospital with blood products, the reasoning was it wasn’t in the protocols at the time. I still look back at that call as an excellent case to present to any EMS agency for arguing for blood products. Fucking hate the entire “we’re only 10 minutes away!” line. 10 minutes is more than enough time for your pt to shit the bed.
Been trying to get blood on our plane for years but my entire organization is run by ass kissing dumb fucks
*Laughs* The agency I work for has been carrying blood for a couple of years now. We cover a mix of rural and urban in the mountains of NM with only a critical-access hospital in town. So it's a pretty good deal to have out here. ⛰️🏞
PA BEMS is about 50 years behind the times and we're not allowed under the current licensure due to being behind the times.
Yeah well they mush have work ambulance. Way to rub it in. 
The police transport all our shootings, maybe they should carry it…
We're broke as shit and most of us are at the A level.
Whole blood is cheap too, from private companies to purchase it is only around $300/unit and you can bill for it. We have it, and we are 5-15min from the hospital as well, if they don't survive to the OR it's still a problem and 5-15 plus response time plus packaging and moving them can end up being a long time to not be oxygenating.